Provider Demographics
NPI:1104065747
Name:FRIEDLAND-STORA, JENNIFER A (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:FRIEDLAND-STORA
Suffix:
Gender:F
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 1:130 72ND ST APT 4J
Mailing Address - Street 2:APARTMENT 4J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2005
Mailing Address - Country:US
Mailing Address - Phone:347-497-4460
Mailing Address - Fax:
Practice Address - Street 1:130 72ND ST APT 4J
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2005
Practice Address - Country:US
Practice Address - Phone:347-497-4460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030431-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist