Provider Demographics
NPI:1760786537
Name:JURUS-DIFABIO, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:JURUS-DIFABIO
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 1:664 STONELEIGH AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:664 STONELEIGH AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3940
Practice Address - Country:US
Practice Address - Phone:845-279-1785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024284-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist