Provider Demographics
NPI:1528241098
Name:GREELEY, JUDITH (PT)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:GREELEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:SOLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:60 ASH RD
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2122
Mailing Address - Country:US
Mailing Address - Phone:914-588-5988
Mailing Address - Fax:845-623-7059
Practice Address - Street 1:60 ASH RD
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-2122
Practice Address - Country:US
Practice Address - Phone:914-588-5988
Practice Address - Fax:845-623-7059
Is Sole Proprietor?:No
Enumeration Date:2007-12-07
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJPTQA00396400225100000X
NY014787-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1733Q5RU1Medicare PIN