Provider Demographics
NPI:1710926910
Name:HERR, JANA LORI (PT, MS)
Entity Type:Individual
Prefix:MS
First Name:JANA
Middle Name:LORI
Last Name:HERR
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2639
Mailing Address - Country:US
Mailing Address - Phone:516-694-4426
Mailing Address - Fax:516-694-4426
Practice Address - Street 1:54 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2639
Practice Address - Country:US
Practice Address - Phone:516-694-4426
Practice Address - Fax:516-694-4426
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019821225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP3621Medicare ID - Type Unspecified
NYQP362Q11W1Medicare PIN