Provider Demographics
NPI:1285020065
Name:MOKAY, JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MOKAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SCHMID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:5849 E CIRCLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8654
Mailing Address - Country:US
Mailing Address - Phone:315-635-5000
Mailing Address - Fax:315-458-2975
Practice Address - Street 1:604 OLD LIVERPOOL RD STE 2
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6033
Practice Address - Country:US
Practice Address - Phone:315-218-1451
Practice Address - Fax:315-451-1752
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04531426Medicaid