Basic Information
| Provider Information | |||||||||
| NPI: | 1376573873 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOLLY | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 ROUTE 299 | ||||||||
| Address2: | FIRSTCARE MEDICAL CENTER | ||||||||
| City: | HIGHLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125282524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456913627 | ||||||||
| FaxNumber: | 8456913641 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 ROUTE 299 | ||||||||
| Address2: | FIRSTCARE MEDICAL CENTER | ||||||||
| City: | HIGHLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125282524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456913627 | ||||||||
| FaxNumber: | 8456913641 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 05/03/2011 | ||||||||
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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 | 016666-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 00273845 | 05 | NY | MEDICAID |