Provider Demographics
NPI:1033721311
Name:RUSZKOWSKI, JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:RUSZKOWSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 MCBAINE AVE SIDE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1611
Mailing Address - Country:US
Mailing Address - Phone:917-439-3052
Mailing Address - Fax:888-686-2968
Practice Address - Street 1:101 ELLIS ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-1118
Practice Address - Country:US
Practice Address - Phone:917-439-3052
Practice Address - Fax:888-686-2968
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01948600225100000X
NY047135225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist