Provider Demographics
NPI:1609103894
Name:BAJARIAS, JOSIE J (PT)
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:J
Last Name:BAJARIAS
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 1:152 ISLIP AVE
Mailing Address - Street 2:STE. 15
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3225
Mailing Address - Country:US
Mailing Address - Phone:631-277-6767
Mailing Address - Fax:631-277-4311
Practice Address - Street 1:152 ISLIP AVE
Practice Address - Street 2:STE. 15
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3225
Practice Address - Country:US
Practice Address - Phone:631-277-6767
Practice Address - Fax:631-277-4311
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist