Provider Demographics
NPI:1861577124
Name:JOSCELYN TRAVERS
Entity type:Organization
Organization Name:JOSCELYN TRAVERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-665-4560
Mailing Address - Street 1:225 HOWELLS RD
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5319
Mailing Address - Country:US
Mailing Address - Phone:631-665-4560
Mailing Address - Fax:
Practice Address - Street 1:225 HOWELLS RD
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5319
Practice Address - Country:US
Practice Address - Phone:631-665-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY203121819OtherMPN
NYGRP496389003OtherHEALTHNOW
NY027442703Medicaid
NY61318OtherMVP
NY203121819OtherGHI HMO
NY0210001OtherAETNA NON-HMO
NY203121819OtherMPN