Basic Information
Provider Information
NPI: 1174825087
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ARISMENDY
FirstName: JASON
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1536 3RD AVE
Address2: 5TH FL
City: NEW YORK
State: NY
PostalCode: 100282167
CountryCode: US
TelephoneNumber: 2128612630
FaxNumber: 2128612685
Practice Location
Address1: 3 E 48TH ST
Address2: FL. 5
City: NEW YORK
State: NY
PostalCode: 100171027
CountryCode: US
TelephoneNumber: 2127531175
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/29/2010
LastUpdateDate: 01/23/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X033068NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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