Provider Demographics
NPI:1093780413
Name:DARBY, JENNIFER (PT)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:DARBY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 ROUTE 22
Mailing Address - Street 2:STE B102
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4359
Mailing Address - Country:US
Mailing Address - Phone:845-279-5111
Mailing Address - Fax:845-279-5121
Practice Address - Street 1:1454 ROUTE 22
Practice Address - Street 2:SUITE B102
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4346
Practice Address - Country:US
Practice Address - Phone:845-279-5111
Practice Address - Fax:845-279-5121
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023515225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
QL9981Medicare ID - Type Unspecified