Basic Information
| Provider Information | |||||||||
| NPI: | 1619992963 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SABELLA | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | OCCUPATIONAL THERAP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 RIDGEVIEW PL | ||||||||
| Address2: | |||||||||
| City: | MOUNT SINAI | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117661720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317477677 | ||||||||
| FaxNumber: | 6313312392 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 BELLE TERRE RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | PORT JEFFERSON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117771935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313313608 | ||||||||
| FaxNumber: | 6313312392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 11/13/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | 009726-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
ID Information
| ID | Type | State | Issuer | Description | QV1371 | 01 | NY | EMPIRE BLUE CROSS BLUE SHIELD | OTHER |