MEDICARE: JENNA RAFFERTY

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
1	225100000X	Physical Therapist	055882	NY

General Provider Information

NPI Number	:	1497680698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA RAFFERTY

Provider Business Mailing Address
First Line	:	576 BROADHOLLOW RD
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-5012
Country	:	US
Telephone Number	:	631-359-5859
Fax Number	:

Provider Business Practice Location Address
First Line	:	266 W PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-3212
Country	:	US
Telephone Number	:	516-862-2664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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Directions to “ JENNA RAFFERTY ” Practice Location

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