Provider Demographics
NPI:1679855241
Name:DEMONTEVERDE, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:DEMONTEVERDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3304 WATERBURY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1554
Mailing Address - Country:US
Mailing Address - Phone:718-931-3000
Mailing Address - Fax:718-514-8228
Practice Address - Street 1:3304 WATERBURY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1554
Practice Address - Country:US
Practice Address - Phone:718-931-3000
Practice Address - Fax:718-514-8228
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030176-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist