Provider Demographics
NPI:1962796458
Name:AZUMA, JARED (DPT)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:AZUMA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10166-0005
Mailing Address - Country:US
Mailing Address - Phone:212-953-9494
Mailing Address - Fax:212-682-2013
Practice Address - Street 1:200 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10166-0005
Practice Address - Country:US
Practice Address - Phone:212-953-9494
Practice Address - Fax:212-682-2013
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist