Dominique Jean, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

001894-1 Issued in NY

Practice address

19544 Woodhull Ave
Hollis, NY 11423-2982

Phone

(646) 528-0327

NPI assigned

Feb 21, 2019

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550707200000",
    "number": "1710444237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13744 LAURELTON PKWY",
            "city": "JAMAICA",
            "state": "NY",
            "postal_code": "114221708",
            "telephone_number": "646-528-0327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19544 WOODHULL AVE",
            "city": "HOLLIS",
            "state": "NY",
            "postal_code": "114232982",
            "telephone_number": "646-528-0327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JEAN",
        "first_name": "DOMINIQUE",
        "name_prefix": "Mr.",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-21",
        "last_updated": "2019-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "001894-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "83-2884615",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTA LISCENSE NUMBER",
            "identifier": "001894-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joan Laurie Jacobs, D.C.,C.D.N.
• Grace Rosalee James
• Selina Ukimmy James, LPN
• Kinza Jamshed
• Sthelle Janvier
• Jeffrey Howard Litwin
• JM Occupational Therapy,PLLC
• Nichole Johnson, LMSW
• Hee NA Joo
• Marie Rose Jorelus

• Physical Therapy Assistant in Hollis, NY
• Providers in Hollis, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.