Provider Demographics
NPI:1265412381
Name:GOLIS, JACEK (MS PT)
Entity type:Individual
Prefix:MR
First Name:JACEK
Middle Name:
Last Name:GOLIS
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:501 WASHINGTON AVENUE
Mailing Address - Street 2:PLEASANTVILLE PHYSICAL THERAPY & SPORTS CARE PC
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570
Mailing Address - Country:US
Mailing Address - Phone:914-741-2767
Mailing Address - Fax:914-741-2776
Practice Address - Street 1:501 WASHINGTON AVENUE
Practice Address - Street 2:PLEASANTVILLE PHYSICAL THERAPY & SPORTS CARE PC
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570
Practice Address - Country:US
Practice Address - Phone:914-741-2767
Practice Address - Fax:914-741-2776
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY025552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0222701OtherORTHONET CIGNA HMO
0222701OtherORTHONET USFH
1177828OtherAETNA HMO
0013701OtherORTHONET AETNA HMO
Q34B8OtherEMPIRE BCBS
0222701OtherORTHONET HEALTHNET
7022766OtherAETNA PPO
0764866OtherCIGNA PPO
Q08M91Medicare UPIN
1177828OtherAETNA HMO