Healthcare Provider Details

I. General information

NPI: 1215083555
Provider Name (Legal Business Name): STEPHANIE JILL WENER MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 WILSON PL
PLAINVIEW NY
11803-2224
US

IV. Provider business mailing address

87 WILSON PL
PLAINVIEW NY
11803-2224
US

V. Phone/Fax

Practice location:
  • Phone: 516-509-7691
  • Fax:
Mailing address:
  • Phone: 516-509-7691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number019120
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: