Provider Demographics
NPI:1588734909
Name:JEFFREY J. FOSS PT, PC
Entity type:Organization
Organization Name:JEFFREY J. FOSS PT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:FOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-761-0850
Mailing Address - Street 1:13 BAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-5822
Mailing Address - Country:US
Mailing Address - Phone:518-761-0850
Mailing Address - Fax:518-745-1351
Practice Address - Street 1:13 BAYWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-5822
Practice Address - Country:US
Practice Address - Phone:518-761-0850
Practice Address - Fax:518-745-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009664-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR55732Medicare UPIN
NYAA1261Medicare ID - Type Unspecified