Provider Demographics
NPI:1962545830
Name:KITSOS ELLINGER, JAYNE MARIE (ATC)
Entity type:Individual
Prefix:
First Name:JAYNE
Middle Name:MARIE
Last Name:KITSOS ELLINGER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:JAYNE
Other - Middle Name:MAIRE
Other - Last Name:KITSOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:220 HOFSTRA UNIVERSITY 101 HOFSTRA DOME
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11549-0001
Mailing Address - Country:US
Mailing Address - Phone:516-463-6952
Mailing Address - Fax:516-463-6275
Practice Address - Street 1:42 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-4111
Practice Address - Country:US
Practice Address - Phone:516-463-6952
Practice Address - Fax:516-463-6275
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY350-012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer