Provider Demographics
NPI:1255108247
Name:GRIFFITHS, JEAN M (LMT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:GRIFFITHS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PARDAM KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2136
Mailing Address - Country:US
Mailing Address - Phone:631-235-3678
Mailing Address - Fax:
Practice Address - Street 1:595 ROUTE 25A STE 20
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2647
Practice Address - Country:US
Practice Address - Phone:631-849-1586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014074225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist