Basic Information
| Provider Information | |||||||||
| NPI: | 1427152891 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JEZDIC | ||||||||
| FirstName: | SASA | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21-26 NEWTOWN AV. | ||||||||
| Address2: | APT. 11 | ||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187091557 | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 WALL ST | ||||||||
| Address2: | 4TH. FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100052201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125146499 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 001272-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.