Provider Demographics
NPI:1720398530
Name:JAYLA PT
Entity Type:Organization
Organization Name:JAYLA PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAMENDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-317-6700
Mailing Address - Street 1:236 RICHMOND VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2606
Mailing Address - Country:US
Mailing Address - Phone:718-317-6700
Mailing Address - Fax:718-816-4677
Practice Address - Street 1:236 RICHMOND VALLEY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2606
Practice Address - Country:US
Practice Address - Phone:718-317-6700
Practice Address - Fax:718-816-4677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020534-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy