Provider Demographics
NPI:1326388356
Name:J E M PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:J E M PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PANA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-769-0675
Mailing Address - Street 1:8635 QUEENS BLVD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4207 KISSENA BLVD
Practice Address - Street 2:CELLAR LEVEL
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3275
Practice Address - Country:US
Practice Address - Phone:646-769-0675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032529-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty