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General NPI Number Information
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NPI Number | 1619053592
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Entity Type | Organization
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Legal Business Name | J-D P.T. INCORPORATED
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 21 JUDY TER
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-3724
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Country | US
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Telephone | 516-721-3167
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Fax | 516-795-1520
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Provider Business Mailing Address
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Address Line | 21 JUDY TER
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City | MASSAPEQUA PARK
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State | NY
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Zip | 11762-3724
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Country | US
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Telephone | 516-721-3167
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Fax | 516-795-1520
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JOSEPH PAUL DABOVICH JR.
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Credential | P.T.
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Telephone | 516-721-3167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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