Provider Demographics
NPI:1104896638
Name:MCNALLY, JENNIFER A (PT)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:MCNALLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-3302
Mailing Address - Country:US
Mailing Address - Phone:845-215-5045
Mailing Address - Fax:845-624-0690
Practice Address - Street 1:7 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-3302
Practice Address - Country:US
Practice Address - Phone:845-215-5045
Practice Address - Fax:845-624-0690
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023877-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000083629OtherGHI
NYDD8589OtherPALMETTO
NYQ20J9OtherBLUE CROSS BLUE SHIELD
NY2341704OtherCIGNA
NY182331OtherANTHEM BC BS
NYQ5WRR1Medicare ID - Type UnspecifiedGROUP ID
NYDD8589OtherPALMETTO