Provider Demographics
NPI:1164558730
Name:SLOAN, JACKI H (DPT)
Entity Type:Individual
Prefix:DR
First Name:JACKI
Middle Name:H
Last Name:SLOAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:JACKI
Other - Middle Name:
Other - Last Name:SIEWERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:500 E 77TH ST APT 330
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10162-0021
Mailing Address - Country:US
Mailing Address - Phone:212-249-1356
Mailing Address - Fax:212-772-8673
Practice Address - Street 1:4 E 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0404
Practice Address - Country:US
Practice Address - Phone:212-249-1356
Practice Address - Fax:212-772-8673
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ57771Medicare ID - Type UnspecifiedSUBSCRIBER ID