Provider Demographics
NPI:1538353115
Name:TODESCO, JEFFERY AMERIGO (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:AMERIGO
Last Name:TODESCO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 37TH ST APT 14
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-6037
Mailing Address - Country:US
Mailing Address - Phone:917-678-1687
Mailing Address - Fax:
Practice Address - Street 1:163 AMSTERDAM AVE #293
Practice Address - Street 2:OUTREACH PHYSICAL THERAPY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:917-620-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029039-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
54974Q49E1Medicare PIN