Basic Information
| Provider Information | |||||||||
| NPI: | 1992783518 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALONEY | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 NEWHAM AVE | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117175624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003640689 | ||||||||
| FaxNumber: | 8885526176 | ||||||||
| Practice Location | |||||||||
| Address1: | 36 PLAZA ST E | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112385039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186361414 | ||||||||
| FaxNumber: | 7188577618 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 022520 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.