Provider Demographics
NPI:1700180940
Name:JABEZ PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:JABEZ PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:MADELEINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINSANGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-238-9554
Mailing Address - Street 1:6125 98TH ST
Mailing Address - Street 2:SUITE 16-N
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1418
Mailing Address - Country:US
Mailing Address - Phone:917-238-9554
Mailing Address - Fax:
Practice Address - Street 1:1520 56TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4737
Practice Address - Country:US
Practice Address - Phone:917-238-9554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23714-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy