Provider Demographics
NPI:1053474973
Name:STEMKOWSKI, GREGORY (MS PT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:STEMKOWSKI
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1215
Mailing Address - Country:US
Mailing Address - Phone:845-353-0147
Mailing Address - Fax:
Practice Address - Street 1:135 ERIE ST E
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1823
Practice Address - Country:US
Practice Address - Phone:845-680-2673
Practice Address - Fax:845-680-2675
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018525-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ01T91Medicare ID - Type UnspecifiedPHYSICAL THERAPY