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General NPI Number Information
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NPI Number | 1649544834
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Entity Type | Organization
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Legal Business Name | MARATHON PHYSICAL THERAPY OF NY PC
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 556B MIDDLE NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11023-1422
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Country | US
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Telephone | 516-487-9810
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Fax | 516-773-7315
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Provider Business Mailing Address
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Address Line | 556B MIDDLE NECK RD
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City | GREAT NECK
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State | NY
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Zip | 11023-1422
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Country | US
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Telephone | 516-487-9810
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Fax | 516-773-7315
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. NEGIN JALAYER
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Credential | PT, DPT
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Telephone | 516-487-9810
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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 | 026322
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License Number State | NY
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