Provider Demographics
NPI:1265675623
Name:DOMINISE, JURY (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:JURY
Middle Name:
Last Name:DOMINISE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 1ST AVE
Mailing Address - Street 2:APT C
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-1722
Mailing Address - Country:US
Mailing Address - Phone:908-285-8620
Mailing Address - Fax:
Practice Address - Street 1:8845 19TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6008
Practice Address - Country:US
Practice Address - Phone:908-285-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030631225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist