Provider Demographics
NPI:1083044093
Name:JAFFEE GROPACK, STACY MICHELLE (PT, PHD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:MICHELLE
Last Name:JAFFEE GROPACK
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 FRANKEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-5035
Mailing Address - Country:US
Mailing Address - Phone:516-419-1347
Mailing Address - Fax:
Practice Address - Street 1:397 FRANKEL BLVD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-5035
Practice Address - Country:US
Practice Address - Phone:516-419-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0089752251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics