1962545830 NPI number — JAYNE MARIE KITSOS ELLINGER ATC

Table of content: JAYNE MARIE KITSOS ELLINGER ATC (NPI 1962545830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962545830 NPI number — JAYNE MARIE KITSOS ELLINGER ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITSOS ELLINGER
Provider First Name:
JAYNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KITSOS
Provider Other First Name:
JAYNE
Provider Other Middle Name:
MAIRE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ATC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962545830
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 HOFSTRA UNIVERSITY 101 HOFSTRA DOME
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEMPSTEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11549-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-463-6952
Provider Business Mailing Address Fax Number:
516-463-6275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 PERSHING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BABYLON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11702-4111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-463-6952
Provider Business Practice Location Address Fax Number:
516-463-6275
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  350-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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