Basic Information
| Provider Information | |||||||||
| NPI: | 1073579975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOSE | ||||||||
| FirstName: | SIMMY | ||||||||
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| NamePrefix: | MS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1840 RELYEA DR | ||||||||
| Address2: | |||||||||
| City: | MERRICK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115662526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166500487 | ||||||||
| FaxNumber: | 7182988531 | ||||||||
| Practice Location | |||||||||
| Address1: | 179 STREET & LINDEN BLVD | ||||||||
| Address2: | |||||||||
| City: | ST. ALBANS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185261000 | ||||||||
| FaxNumber: | 7182898531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 023216 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.