Basic Information
Provider Information
NPI: 1306553045
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMIREZ PENA
FirstName: JENNIFFER
MiddleName: ALEXANDRA
NamePrefix:  
NameSuffix:  
Credential: PT, DPT
OtherOrganizationName:  
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Mailing Information
Address1: 31 E 32ND ST FL 4
Address2:  
City: NEW YORK
State: NY
PostalCode: 100165595
CountryCode: US
TelephoneNumber: 2127592282
FaxNumber: 2123792123
Practice Location
Address1: 1 CENTRAL PARK S
Address2:  
City: NEW YORK
State: NY
PostalCode: 100191732
CountryCode: US
TelephoneNumber: 6469735432
FaxNumber: 2124004209
Other Information
ProviderEnumerationDate: 11/02/2022
LastUpdateDate: 11/02/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/02/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X049181-01NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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