Provider Demographics
NPI:1891874442
Name:BERNSLEY-JAFFE, ELLEN (BSPT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BERNSLEY-JAFFE
Suffix:
Gender:F
Credentials:BSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 NEW YORK AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-351-7676
Mailing Address - Fax:631-351-7667
Practice Address - Street 1:755 NEW YORK AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-351-7676
Practice Address - Fax:631-351-7667
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0084671225100000X
NY84671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
QM6341OtherBCBS
QM6342OtherBCBS
Q60802Medicare ID - Type Unspecified