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NPI Code Detail

MEDICARE: JACOB M JANSEN DPT

MEDICARE: JACOB M JANSEN DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist031721NY

General Provider Information

NPI Number : 1326270711
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB M JANSEN DPT
Provider Business Mailing Address
First Line : 54 MURRAY ST
Second Line : C/O EQUINOX
City : NEW YORK
State : NY
Zip : 10007-2219
Country : US
Telephone Number : 212-453-4622
Fax Number : 212-453-4623
Provider Business Practice Location Address
First Line : 54 MURRAY ST
Second Line : C/O EQUINOX
City : NEW YORK
State : NY
Zip : 10007-2219
Country : US
Telephone Number : 212-453-4622
Fax Number : 212-453-4623
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2009
Last Update Date : 08/18/2009

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