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General NPI Number Information
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NPI Number | 1417063405
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Entity Type | Individual
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Provider Name | ENRIQUE CARLOS JINETE DPT
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 30 N MAIN ST SUITE 2
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City | PORT CHESTER
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State | NY
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Zip | 10573-4256
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Country | US
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Telephone | 914-939-3143
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Fax | 914-939-3120
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Provider Business Mailing Address
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Address Line | 30 N MAIN ST SUITE 2
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City | PORT CHESTER
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State | NY
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Zip | 10573-4256
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Country | US
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Telephone | 917-864-7706
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Fax | 914-939-3120
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 024127
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License Number State | NY
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