Provider Demographics
NPI:1598140253
Name:JEKLINSKI, EDWARD JAMES (DPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JAMES
Last Name:JEKLINSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 ELDERT ST
Mailing Address - Street 2:APT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-1304
Mailing Address - Country:US
Mailing Address - Phone:973-714-1747
Mailing Address - Fax:
Practice Address - Street 1:147 W 35TH ST
Practice Address - Street 2:SUITE 407
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2110
Practice Address - Country:US
Practice Address - Phone:212-842-0080
Practice Address - Fax:917-591-8494
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist