Provider Demographics
NPI:1164702304
Name:BAMBY, JASON
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BAMBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9511 SHORE RD SUITE 107
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7510
Mailing Address - Country:US
Mailing Address - Phone:718-873-6513
Mailing Address - Fax:
Practice Address - Street 1:9511 SHORE RD SUITE 107
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7510
Practice Address - Country:US
Practice Address - Phone:718-873-6513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006500225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant