Provider Demographics
NPI:1689142200
Name:BELLANICH, JEFFREY P (PT, DPT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:BELLANICH
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MOUNT MORRIS PARK W APT 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-6512
Mailing Address - Country:US
Mailing Address - Phone:669-696-5556
Mailing Address - Fax:
Practice Address - Street 1:10 MOUNT MORRIS PARK W APT 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6512
Practice Address - Country:US
Practice Address - Phone:669-696-5556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301989225100000X
NY043707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist