Provider Demographics
NPI:1235389586
Name:TOBACK, JILL BARI
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:BARI
Last Name:TOBACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 OAKS HUNT RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11020-1206
Mailing Address - Country:US
Mailing Address - Phone:516-521-3401
Mailing Address - Fax:
Practice Address - Street 1:18 OAKS HUNT RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11020-1206
Practice Address - Country:US
Practice Address - Phone:516-521-3401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency