Provider Demographics
NPI:1679155352
Name:JASON LAKRITZ DPT PT PC
Entity Type:Organization
Organization Name:JASON LAKRITZ DPT PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKRITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-926-7039
Mailing Address - Street 1:6 SHAKER CT
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-8041
Mailing Address - Country:US
Mailing Address - Phone:845-926-7039
Mailing Address - Fax:212-223-0198
Practice Address - Street 1:6 SHAKER CT
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-8041
Practice Address - Country:US
Practice Address - Phone:845-926-7039
Practice Address - Fax:212-223-0198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY035145OtherLICENSE