Provider Demographics
NPI:1104527357
Name:JOHN, ANN MARY
Entity type:Individual
Prefix:
First Name:ANN MARY
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26007 UNION TPKE # 2
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1345
Mailing Address - Country:US
Mailing Address - Phone:347-433-1708
Mailing Address - Fax:
Practice Address - Street 1:1605 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2603
Practice Address - Country:US
Practice Address - Phone:516-616-0942
Practice Address - Fax:516-616-0943
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist