Provider Demographics
NPI:1730552217
Name:ROTHMAN, JACLYN (PT)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:ROTHMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BLOOMFIELD ST
Mailing Address - Street 2:APARTMENT 3
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4652
Mailing Address - Country:US
Mailing Address - Phone:732-766-9994
Mailing Address - Fax:
Practice Address - Street 1:430 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:646-929-7970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 037434225100000X
NJ40QA01543900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist