Provider Demographics
NPI:1437376670
Name:WOLFF, JAYNE DEBRA (MA PT)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:DEBRA
Last Name:WOLFF
Suffix:
Gender:F
Credentials:MA PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:34 FOX HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1332
Mailing Address - Country:US
Mailing Address - Phone:516-626-1966
Mailing Address - Fax:516-626-1966
Practice Address - Street 1:34 FOX HOLLOW LN
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1332
Practice Address - Country:US
Practice Address - Phone:516-626-1966
Practice Address - Fax:516-626-1966
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQQ1751Medicare ID - Type Unspecified