Healthcare Provider Details

I. General information

NPI: 1568598746
Provider Name (Legal Business Name): JENNIFER MARIE DESHLER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 MONTAUK HWY # 2
OAKDALE NY
11769-1434
US

IV. Provider business mailing address

76 YAPHANK AVE
YAPHANK NY
11980-9705
US

V. Phone/Fax

Practice location:
  • Phone: 631-218-1545
  • Fax:
Mailing address:
  • Phone: 631-525-2390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number027905-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: