Provider Demographics
NPI:1629004056
Name:CATINO, JENNIFER SANDRA (MPT, LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SANDRA
Last Name:CATINO
Suffix:
Gender:F
Credentials:MPT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PINE WEST PLAZA, STE 111
Mailing Address - Street 2:315 WASHINGTON AVE EXTENSION
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3735
Mailing Address - Country:US
Mailing Address - Phone:518-424-6487
Mailing Address - Fax:518-608-1035
Practice Address - Street 1:1 PINE WEST PLAZA, STE 111
Practice Address - Street 2:315 WASHINGTON AVE EXTENSION
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-424-6487
Practice Address - Fax:518-608-1035
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017840-1174400000X
NY023932-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA6094Medicare ID - Type Unspecified