Provider Demographics
NPI:1184221533
Name:STASYSZYN, GABRIEL (DPT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:STASYSZYN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 E 74TH ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3235
Mailing Address - Country:US
Mailing Address - Phone:466-762-4414
Mailing Address - Fax:646-461-2017
Practice Address - Street 1:159 E 74TH ST UNIT 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3235
Practice Address - Country:US
Practice Address - Phone:466-762-4414
Practice Address - Fax:646-461-2017
Is Sole Proprietor?:No
Enumeration Date:2020-10-07
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT028854225100000X
NY050475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist