Provider Demographics
NPI:1376576082
Name:MATYNIA, ZBIGNIEW (PT)
Entity Type:Individual
Prefix:
First Name:ZBIGNIEW
Middle Name:
Last Name:MATYNIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GRASMERE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4508
Mailing Address - Country:US
Mailing Address - Phone:718-524-8193
Mailing Address - Fax:
Practice Address - Street 1:112 GREENPOINT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-2296
Practice Address - Country:US
Practice Address - Phone:718-349-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018718225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02104488Medicaid
NYA400028463Medicare PIN
NYS98758Medicare UPIN
NY02104488Medicaid