Provider Demographics
NPI:1568687572
Name:PRESTON, MARY JANE M (PT, MS)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:M
Last Name:PRESTON
Suffix:
Gender:F
Credentials:PT, MS
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Mailing Address - Street 1:475 NORTHERN BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4819
Mailing Address - Country:US
Mailing Address - Phone:516-829-0030
Mailing Address - Fax:516-466-7723
Practice Address - Street 1:475 NORTHERN BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4819
Practice Address - Country:US
Practice Address - Phone:516-829-0030
Practice Address - Fax:516-466-7723
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2016-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC4717225100000X
NY007948225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC69160OtherBCBS
NC7418809Medicaid
7269160OtherAETNA
187782OtherMEDCOST
8300041KOtherMEDICAID CBRS
6400040OtherUNITED HEALTHCARE