Provider Demographics
NPI:1215042841
Name:FOSS, JEFFREY JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JOSEPH
Last Name:FOSS
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 1:13 BAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-5822
Mailing Address - Country:US
Mailing Address - Phone:518-761-0850
Mailing Address - Fax:518-745-1351
Practice Address - Street 1:13 BAYWOOD DR
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-5822
Practice Address - Country:US
Practice Address - Phone:518-761-0850
Practice Address - Fax:518-745-1351
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009664-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY43151OtherMVP HEALTH PLAN
NYQN1851OtherEMPIRE BC/BS
NY000492286002OtherBLUE SHIELD NENY
NY10000675OtherCDPHP
NYR55732Medicare UPIN
NYQN1851OtherEMPIRE BC/BS