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Jeremy C Vandevender

Physical Therapist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

4434 Amboy Rd, Staten Island, NY 10312-3866

PECOS Enrollment

Based on the most recent information from CMS, provider Jeremy C Vandevender does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 34 days ago.

Profile Details

Provider ID
1487691416
Provider Type
Individual
Full Name
Vandevender, Jeremy C
Credential
P.T.

Gender
Male
Sole Proprietor
No
Enumeration Date
5/31/2006
Last Updated
11/10/2009

Contact Information

Practice Location

4434 Amboy Rd, Staten Island, NY 10312-3866

(718) 227-7015

(718) 227-6411

Mailing Location

4175 Veterans Memorial Hwy, Suite 202, Ronkonkoma, NY 11779-7639

(631) 580-5200

(631) 580-5222

Provider Taxonomies

Code	Description	License
Code 225100000X Primary	Description Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License 021302-1 New York
Code 225100000X	Description Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License 40QA00972700 New Jersey

Provider Identifiers

ID	Description	Issuer
ID 02584283	Description Medicaid	Issuer Unlisted New York

Jeremy C Vandevender

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Vlassenko, Nicholas

Balboa Pt

In Mobility Pt Pllc

Smith, Tara Nelson

Vladimir Fedosseev Physical Therapy Pc

North Shore Pt Of Ny Pc

Nemtsova, Yelena

Bhatt, Krishma Sanjay

Bhavsar, Zankhana

Holtzer Physical Therapy Pllc