Provider Demographics
NPI:1487181442
Name:JELINEK, STEPHEN GERARD (PTA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:GERARD
Last Name:JELINEK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 SOUTH AVE APT 1J
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07062-1928
Mailing Address - Country:US
Mailing Address - Phone:908-514-9372
Mailing Address - Fax:
Practice Address - Street 1:1165 EASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1613
Practice Address - Country:US
Practice Address - Phone:732-246-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-20
Last Update Date:2017-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00272200225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant