Provider Demographics
NPI:1528664737
Name:JARONCZYK, JACQUELYN JOSEPHINE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:JOSEPHINE
Last Name:JARONCZYK
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 1:55 LUMBER RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3308
Mailing Address - Country:US
Mailing Address - Phone:516-304-5373
Mailing Address - Fax:
Practice Address - Street 1:55 LUMBER RD STE 105
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3308
Practice Address - Country:US
Practice Address - Phone:516-304-5373
Practice Address - Fax:516-304-5375
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046795208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation