Healthcare Provider Details

I. General information

NPI: 1295934222
Provider Name (Legal Business Name): MELISSA JEAN JARZYNSKI M.S, P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 07/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 PEACH LAKE RD
NORTH SALEM NY
10560-1321
US

IV. Provider business mailing address

60 JUNE RD PO BOX 29
NORTH SALEM NY
10560-1713
US

V. Phone/Fax

Practice location:
  • Phone: 914-874-6932
  • Fax:
Mailing address:
  • Phone: 914-772-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number028298-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01272400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: