MEDICARE: JORDAN PLACELLA

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	043468	NY

General Provider Information

NPI Number	:	1821556895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN PLACELLA

Provider Business Mailing Address
First Line	:	93 JASMINE LN
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-3617
Country	:	US
Telephone Number	:	631-742-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	93 JASMINE LN
Second Line	:
City	:	EAST NORTHPORT
State	:	NY
Zip	:	11731-3617
Country	:	US
Telephone Number	:	631-742-7111
Fax Number	:

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

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	06/05/2024

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