Provider Demographics
NPI:1174879787
Name:JAY ITZKOWITZ M.S.P.T. INC.
Entity type:Organization
Organization Name:JAY ITZKOWITZ M.S.P.T. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ITZKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-558-9197
Mailing Address - Street 1:9980 CENTRAL PARK BLVD N
Mailing Address - Street 2:220
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1762
Mailing Address - Country:US
Mailing Address - Phone:561-558-9197
Mailing Address - Fax:561-558-8868
Practice Address - Street 1:9980 CENTRAL PARK BLVD N
Practice Address - Street 2:220
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1762
Practice Address - Country:US
Practice Address - Phone:561-558-9197
Practice Address - Fax:561-558-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16815261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP63867Medicare UPIN
FLY7079Medicare PIN