Provider Demographics
NPI:1942468467
Name:JAMAICA PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:JAMAICA PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAOGUN
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:718-297-3699
Mailing Address - Street 1:9050 PARSONS BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-6052
Mailing Address - Country:US
Mailing Address - Phone:718-297-3699
Mailing Address - Fax:718-297-3680
Practice Address - Street 1:9050 PARSONS BLVD
Practice Address - Street 2:SUITE 308
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6052
Practice Address - Country:US
Practice Address - Phone:718-297-3699
Practice Address - Fax:718-297-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
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
NY02829Medicare PIN