Provider Demographics
NPI:1316598154
Name:KRASNER, JAMIE L (PT, DPT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:KRASNER
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 1:1377 MOTOR PKWY STE 307
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-5258
Mailing Address - Country:US
Mailing Address - Phone:631-580-5200
Mailing Address - Fax:631-580-5222
Practice Address - Street 1:344 DELSEA DR STE 4
Practice Address - Street 2:
Practice Address - City:MALAGA
Practice Address - State:NJ
Practice Address - Zip Code:08328-4400
Practice Address - Country:US
Practice Address - Phone:856-694-0881
Practice Address - Fax:856-694-0885
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01881900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist