Provider Demographics
NPI:1467408757
Name:CHAMOUN, JENNY (PT)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:CHAMOUN
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 1:180 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6378
Mailing Address - Country:US
Mailing Address - Phone:212-595-4500
Mailing Address - Fax:212-595-4578
Practice Address - Street 1:180 W 80TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6378
Practice Address - Country:US
Practice Address - Phone:212-595-4500
Practice Address - Fax:212-595-4578
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100021318Medicare PIN
NY1467408757Medicare UPIN
NY1932437134Medicare UPIN
NYA400021319Medicare PIN