Provider Demographics
NPI:1780900431
Name:ENGELBERG, JACK (DPT)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:ENGELBERG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4743
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:718-252-0615
Practice Address - Street 1:2918 AVENUE M
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4617
Practice Address - Country:US
Practice Address - Phone:718-252-0625
Practice Address - Fax:718-252-0615
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031799-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist