Provider Demographics
NPI:1104845551
Name:MORGENSTERN, JEFFREY (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:MORGENSTERN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 RALEIGH LN
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2312
Mailing Address - Country:US
Mailing Address - Phone:917-804-5220
Mailing Address - Fax:516-792-0044
Practice Address - Street 1:849 RALEIGH LN
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2312
Practice Address - Country:US
Practice Address - Phone:917-804-5220
Practice Address - Fax:516-792-0044
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023917-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ07C31Medicare ID - Type Unspecified
NYQ07C31Medicare PIN