Provider Demographics
NPI:1205080231
Name:GIFFIN, JOEL S (DPT, CHT)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:S
Last Name:GIFFIN
Suffix:
Gender:M
Credentials:DPT, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W 36TH ST
Mailing Address - Street 2:RM 407
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7797
Mailing Address - Country:US
Mailing Address - Phone:212-579-3539
Mailing Address - Fax:212-579-3530
Practice Address - Street 1:2255 BROADWAY
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5872
Practice Address - Country:US
Practice Address - Phone:212-579-3539
Practice Address - Fax:212-579-3530
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist