Provider Demographics
NPI:1225593007
Name:ZAHARIOUDAKIS, GREGORY (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:ZAHARIOUDAKIS
Suffix:
Gender:M
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 1:516 BRADLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1116
Mailing Address - Country:US
Mailing Address - Phone:732-865-3331
Mailing Address - Fax:
Practice Address - Street 1:69 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1426
Practice Address - Country:US
Practice Address - Phone:973-248-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01839500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist