Provider Demographics
NPI:1356999239
Name:BEN-JACOB, BAS SHEVA (DPT)
Entity type:Individual
Prefix:
First Name:BAS SHEVA
Middle Name:
Last Name:BEN-JACOB
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 KEARSING PKWY APT B
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-7235
Mailing Address - Country:US
Mailing Address - Phone:347-785-0327
Mailing Address - Fax:
Practice Address - Street 1:46 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-1321
Practice Address - Country:US
Practice Address - Phone:845-356-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics