Provider Demographics
NPI:1114683034
Name:JUSZCZYK, OLIWIA M (PT DPT)
Entity Type:Individual
Prefix:
First Name:OLIWIA
Middle Name:M
Last Name:JUSZCZYK
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 2ND AVE RM 701
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4500
Mailing Address - Country:US
Mailing Address - Phone:212-499-0876
Mailing Address - Fax:
Practice Address - Street 1:62 E 88TH ST FL LL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1151
Practice Address - Country:US
Practice Address - Phone:212-988-2501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047909-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist