Healthcare Provider Details

I. General information

NPI: 1841668282
Provider Name (Legal Business Name): JEREMY ALLEN SAJDAK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 UNION ST
NORTH CHILI NY
14514
US

IV. Provider business mailing address

1130 CROSSPOINTE LN SUITE 6
WEBSTER NY
14580-2986
US

V. Phone/Fax

Practice location:
  • Phone: 585-594-1688
  • Fax: 585-594-9273
Mailing address:
  • Phone: 585-347-4990
  • Fax: 585-347-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number039435
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: