Provider Demographics
NPI:1184879892
Name:CRONIN, JILL MELISSA (MSPT)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MELISSA
Last Name:CRONIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:MISS
Other - First Name:JILL
Other - Middle Name:MELISSA
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:PURDYS
Mailing Address - State:NY
Mailing Address - Zip Code:10578
Mailing Address - Country:US
Mailing Address - Phone:914-384-0450
Mailing Address - Fax:
Practice Address - Street 1:12 RIDGE WAY
Practice Address - Street 2:
Practice Address - City:PURDYS
Practice Address - State:NY
Practice Address - Zip Code:10578-1404
Practice Address - Country:US
Practice Address - Phone:914-384-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015123-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics