Provider Demographics
NPI:1851486526
Name:J.G.WELLNESS PHYSICAL THERAPY,PC
Entity Type:Organization
Organization Name:J.G.WELLNESS PHYSICAL THERAPY,PC
Other - Org Name:J.G.WELLNESS PT,PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAROSLAW
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:SOLOMIANKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:516-476-1130
Mailing Address - Street 1:4 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3706
Mailing Address - Country:US
Mailing Address - Phone:516-931-2780
Mailing Address - Fax:516-938-1129
Practice Address - Street 1:4 PASADENA DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3706
Practice Address - Country:US
Practice Address - Phone:516-931-2780
Practice Address - Fax:516-938-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1WAR1Medicare ID - Type UnspecifiedPROVIDER NUMBER