Provider Demographics
NPI:1518309517
Name:JAMROG, CINDY DIANE (MS ED)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:DIANE
Last Name:JAMROG
Suffix:
Gender:M
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 GETZ AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2177
Mailing Address - Country:US
Mailing Address - Phone:718-317-6435
Mailing Address - Fax:
Practice Address - Street 1:65 GETZ AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-2177
Practice Address - Country:US
Practice Address - Phone:718-317-6435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY721868174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist