Provider Demographics
NPI:1154665396
Name:ADAM PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:ADAM PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ECS, OCS
Authorized Official - Phone:646-863-8353
Mailing Address - Street 1:651 W 180TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4802
Mailing Address - Country:US
Mailing Address - Phone:646-918-7816
Mailing Address - Fax:646-661-2151
Practice Address - Street 1:651 W 180TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4802
Practice Address - Country:US
Practice Address - Phone:646-918-7816
Practice Address - Fax:646-661-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-10
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY0218372251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04988670Medicaid
NY02231652Medicaid