Provider Demographics
NPI:1932887270
Name:JEANTY, SEIDE VAL
Entity Type:Individual
Prefix:
First Name:SEIDE
Middle Name:VAL
Last Name:JEANTY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07933-2012
Mailing Address - Country:US
Mailing Address - Phone:908-991-3761
Mailing Address - Fax:
Practice Address - Street 1:644 VALLEY RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:NJ
Practice Address - Zip Code:07933-2012
Practice Address - Country:US
Practice Address - Phone:908-991-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02183900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist