Provider Demographics
NPI:1023182862
Name:ZAFFARESE, JACKIE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:
Last Name:ZAFFARESE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:JEROLIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:3 OAKMONT CT
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2509
Mailing Address - Country:US
Mailing Address - Phone:609-947-0542
Mailing Address - Fax:609-918-0601
Practice Address - Street 1:400 US HIGHWAY 130
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2792
Practice Address - Country:US
Practice Address - Phone:609-918-0600
Practice Address - Fax:609-918-0601
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist