Provider Demographics
NPI:1053927137
Name:TROJANOWSKI, BETTE JAYNE
Entity type:Individual
Prefix:
First Name:BETTE
Middle Name:JAYNE
Last Name:TROJANOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:JAMESPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11947-0356
Mailing Address - Country:US
Mailing Address - Phone:631-566-6430
Mailing Address - Fax:
Practice Address - Street 1:1394 ROANOKE AVE STE A
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2100
Practice Address - Country:US
Practice Address - Phone:631-257-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105367104100000X
NY012016-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker