Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | ||
Y | 2251N0400X | Physical Therapist - Neurology | 035249 | NY |
NPI | 1275163297 |
---|---|
Provider Name | Dr. Jenna Desimone |
First Address | New York, NY 10016-2708 |
Second Address | New York, NY 10016-2708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2020 |
Last Update Date | 17/01/2020 |