Basic Information
| Provider Information | |||||||||
| NPI: | 1235686619 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ROE | ||||||||
| FirstName: | JENA | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2142 UTOPIA PKWY | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113574142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188196805 | ||||||||
| FaxNumber: | 3478419109 | ||||||||
| Practice Location | |||||||||
| Address1: | 420 LEXINGTON AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101700002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129730655 | ||||||||
| FaxNumber: | 2129730656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2016 | ||||||||
| LastUpdateDate: | 09/02/2016 | ||||||||
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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 | 040720 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.