Provider Demographics
NPI:1023288636
Name:KIPNIS, JARED A (PT, DPT, COMT)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:A
Last Name:KIPNIS
Suffix:
Gender:M
Credentials:PT, DPT, COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HEMPSTEAD AVE
Mailing Address - Street 2:SUITE 258
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4033
Mailing Address - Country:US
Mailing Address - Phone:516-536-3800
Mailing Address - Fax:516-536-4588
Practice Address - Street 1:30 HEMPSTEAD AVE
Practice Address - Street 2:SUITE 258
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4033
Practice Address - Country:US
Practice Address - Phone:516-536-3800
Practice Address - Fax:516-536-4588
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028738-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist