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General NPI Number Information
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NPI Number | 1295979151
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Entity Type | Individual
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Provider Name | VIDA JONG MSPT
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Gender | Female
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 08/30/2011
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Provider Practice Location Address
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Address Line | 292 MADISON AVE 2ND FLOOR
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City | NEW YORK
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State | NY
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Zip | 10017-6307
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Country | US
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Telephone | 212-418-0321
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Fax |
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Provider Business Mailing Address
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Address Line | 327 E 34TH ST APT. 2D
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City | NEW YORK
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State | NY
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Zip | 10016-4943
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Country | US
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Telephone | 917-309-0417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 019406-1
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License Number State | NY
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