Provider Demographics
NPI:1063052017
Name:JAMANDRE, PJ JAVELLANA (PT, DPT)
Entity type:Individual
Prefix:
First Name:PJ
Middle Name:JAVELLANA
Last Name:JAMANDRE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 WILLIAMSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-4109
Mailing Address - Country:US
Mailing Address - Phone:718-231-5600
Mailing Address - Fax:347-980-2471
Practice Address - Street 1:2705 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4109
Practice Address - Country:US
Practice Address - Phone:718-231-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027783208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation