Provider Demographics
NPI:1063641132
Name:DATU, ADRIAN B (DPT, PT)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:B
Last Name:DATU
Suffix:
Gender:M
Credentials:DPT, PT
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Mailing Address - Street 1:333 EARLE OVINGTON BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3610
Mailing Address - Country:US
Mailing Address - Phone:516-321-2400
Mailing Address - Fax:516-321-2424
Practice Address - Street 1:723 SEVENTH AVE
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6832
Practice Address - Country:US
Practice Address - Phone:212-315-9578
Practice Address - Fax:212-315-9586
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA01316900225100000X
MD23540225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ161295TX5Medicare Oscar/Certification
NYQ4WFH1Medicare PIN