Basic Information
| Provider Information | |||||||||
| NPI: | 1700123619 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSE | ||||||||
| FirstName: | JEFFREY | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2142 UTOPIA PKWY | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113574142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187670610 | ||||||||
| FaxNumber: | 5167509076 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 RTE 17 | ||||||||
| Address2: | |||||||||
| City: | MAHWAH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074302141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015298322 | ||||||||
| FaxNumber: | 2015298377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2013 | ||||||||
| LastUpdateDate: | 01/11/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00840800 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.