Organization
GJ, PHYSICAL THERAPIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GHOLAMREZA JAHANARA DR OF PHYSICAL THERA (PRESIDENT)
(646) 417-1300
Entity
Organization
Contact information
Practice address
1822 CORPORAL KENNEDY ST, BAYSIDE, NY 11360-1447
(646) 417-1300
Mailing address
18-22 CORPORAL KENNEDY STREET, BAYSIDE, NY 11360
(646) 417-1300
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
019910-1
NY
Other
Enumeration date
08/27/2015
Last updated
08/27/2015
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