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NPI Code Detail

MEDICARE: DR. DAVID JAY ETTINGER DPT

MEDICARE: DR. DAVID JAY ETTINGER 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 Therapist029579NY

General Provider Information

NPI Number : 1629262993
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID JAY ETTINGER DPT
Provider Business Mailing Address
First Line : 740 TURF RD
Second Line :
City : VALLEY STREAM
State : NY
Zip : 11581-3506
Country : US
Telephone Number : 719-336-4900
Fax Number : 718-336-4990
Provider Business Practice Location Address
First Line : 1716 CONEY ISLAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-5801
Country : US
Telephone Number : 917-658-7726
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2007
Last Update Date : 11/01/2022

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