Provider Demographics
NPI:1114439858
Name:BASZYNSKI, BARTOSZ (DPT)
Entity Type:Individual
Prefix:
First Name:BARTOSZ
Middle Name:
Last Name:BASZYNSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:BART
Other - Middle Name:
Other - Last Name:BASZYNSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:5942 SUMMERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5937
Mailing Address - Country:US
Mailing Address - Phone:917-685-6181
Mailing Address - Fax:
Practice Address - Street 1:672 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1506
Practice Address - Country:US
Practice Address - Phone:718-282-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist