Basic Information
Provider Information
NPI: 1528396264
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAGARINO
FirstName: JENNIFER
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2700 WESTCHESTER AVE
Address2: FL 2
City: PURCHASE
State: NY
PostalCode: 105772547
CountryCode: US
TelephoneNumber: 9146075730
FaxNumber: 9144571195
Practice Location
Address1: 1281 E MAIN ST
Address2:  
City: STAMFORD
State: CT
PostalCode: 069023544
CountryCode: US
TelephoneNumber: 2032102840
FaxNumber: 2032102841
Other Information
ProviderEnumerationDate: 11/18/2009
LastUpdateDate: 06/21/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X008980CTY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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