Provider Demographics
NPI:1932264256
Name:KUNNEL, JAYA (MA PT)
Entity Type:Individual
Prefix:MS
First Name:JAYA
Middle Name:
Last Name:KUNNEL
Suffix:
Gender:F
Credentials:MA PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 SEARINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1125
Mailing Address - Country:US
Mailing Address - Phone:576-621-7072
Mailing Address - Fax:516-621-7066
Practice Address - Street 1:91 SEARINGTOWN RD
Practice Address - Street 2:
Practice Address - City:ALBERTSON
Practice Address - State:NY
Practice Address - Zip Code:11507-1125
Practice Address - Country:US
Practice Address - Phone:516-621-7072
Practice Address - Fax:516-621-7066
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8855174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6604045OtherP.T.
NY218121POtherP.T
NY962474OtherP.T.
NYANC 1590OtherP.T.
NY962474OtherP.T.