Provider Demographics
NPI:1598866576
Name:FUTTERMAN, STACEY JILL (PT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:JILL
Last Name:FUTTERMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 W 20TH ST STE 607
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3718
Mailing Address - Country:US
Mailing Address - Phone:212-226-2066
Mailing Address - Fax:212-500-0039
Practice Address - Street 1:187 MILLBURN AVE STE 101
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1845
Practice Address - Country:US
Practice Address - Phone:212-226-2066
Practice Address - Fax:212-500-0039
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01105700225100000X
025816-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist