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General NPI Number Information
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NPI Number | 1336919125
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Entity Type | Individual
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Provider Name | MARICEL COLLARGA JAHI
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Gender | Female
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Dates
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Enumeration Date | 01/03/2024
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 666 W 207TH ST APT 5B
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City | NEW YORK
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State | NY
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Zip | 10034-1954
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Country | US
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Telephone | 917-406-6263
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Fax |
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Provider Business Mailing Address
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Address Line | 4312 DITMARS BLVD
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City | ASTORIA
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State | NY
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Zip | 11105-1337
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Country | US
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Telephone | 317-406-6263
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 01310001
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License Number State | NY
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