Provider Demographics
NPI:1477372225
Name:DURSO, JAMIE ANN
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:DURSO
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 1:14927 TAHOE ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-3028
Mailing Address - Country:US
Mailing Address - Phone:718-864-7233
Mailing Address - Fax:
Practice Address - Street 1:16111 CROSSBAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3442
Practice Address - Country:US
Practice Address - Phone:718-843-3211
Practice Address - Fax:718-843-3219
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP131540225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant