Provider Demographics
NPI:1164012241
Name:SAMODULSKI PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:SAMODULSKI PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SAMODULSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-489-8441
Mailing Address - Street 1:17 WEEKS AVE
Mailing Address - Street 2:
Mailing Address - City:OYSTER BAY
Mailing Address - State:NY
Mailing Address - Zip Code:11771-2308
Mailing Address - Country:US
Mailing Address - Phone:516-340-9501
Mailing Address - Fax:516-340-9501
Practice Address - Street 1:68 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OYSTER BAY
Practice Address - State:NY
Practice Address - Zip Code:11771-2284
Practice Address - Country:US
Practice Address - Phone:516-340-9501
Practice Address - Fax:516-340-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty