Provider Demographics
NPI:1508132010
Name:GAMATERO, JAIME M JR (PT)
Entity Type:Individual
Prefix:MR
First Name:JAIME
Middle Name:M
Last Name:GAMATERO
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11051 62ND DR
Mailing Address - Street 2:2F
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1234
Mailing Address - Country:US
Mailing Address - Phone:646-642-6598
Mailing Address - Fax:718-679-9653
Practice Address - Street 1:11051 62ND DR
Practice Address - Street 2:2F
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1234
Practice Address - Country:US
Practice Address - Phone:347-968-8658
Practice Address - Fax:718-679-9653
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027029225100000X
NJ40QA01299200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist