Provider Demographics
NPI:1134315112
Name:PIETRUS, KAZIMIERZ
Entity Type:Individual
Prefix:
First Name:KAZIMIERZ
Middle Name:
Last Name:PIETRUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 1/2 PROSPECT AVE # 1
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-8668
Mailing Address - Country:US
Mailing Address - Phone:201-232-5311
Mailing Address - Fax:
Practice Address - Street 1:62 1/2 PROSPECT AVE # 1
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-8668
Practice Address - Country:US
Practice Address - Phone:201-232-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist