Provider Demographics
NPI:1417063405
Name:JINETE, ENRIQUE CARLOS (DPT)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:CARLOS
Last Name:JINETE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 N MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-4256
Mailing Address - Country:US
Mailing Address - Phone:917-864-7706
Mailing Address - Fax:914-939-3120
Practice Address - Street 1:30 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4256
Practice Address - Country:US
Practice Address - Phone:914-939-3143
Practice Address - Fax:914-939-3120
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00273417OtherRAILROAD CARRIER MEDICARE
NY02962334Medicaid
NY02962334Medicaid
NYP00273417OtherRAILROAD CARRIER MEDICARE