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General NPI Number Information
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NPI Number | 1568687572
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Entity Type | Individual
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Provider Name | MARY JANE M PRESTON PT, MS
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 06/14/2016
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Provider Practice Location Address
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Address Line | 475 NORTHERN BLVD SUITE 11
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City | GREAT NECK
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State | NY
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Zip | 11021-4819
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Country | US
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Telephone | 516-829-0030
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Fax | 516-466-7723
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Provider Business Mailing Address
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Address Line | 475 NORTHERN BLVD SUITE 11
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City | GREAT NECK
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State | NY
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Zip | 11021-4819
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Country | US
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Telephone | 516-829-0030
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Fax | 516-466-7723
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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 | 4717
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 007948
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License Number State | NY
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