Provider Demographics
NPI:1356314884
Name:BUBEL, JILL TERI (PT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:TERI
Last Name:BUBEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AUSTIN CT
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3628
Mailing Address - Country:US
Mailing Address - Phone:845-471-3017
Mailing Address - Fax:845-471-3073
Practice Address - Street 1:2 AUSTIN CT
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3628
Practice Address - Country:US
Practice Address - Phone:845-471-3017
Practice Address - Fax:845-471-3073
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018294-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQM0221Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION