Provider Demographics
NPI:1417923103
Name:DRYGAS, THADDEUS EDWARD (CPO)
Entity Type:Individual
Prefix:MR
First Name:THADDEUS
Middle Name:EDWARD
Last Name:DRYGAS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:MR
Other - First Name:TED
Other - Middle Name:
Other - Last Name:DRYGAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:95 NEW CLARKSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-5203
Mailing Address - Country:US
Mailing Address - Phone:845-426-6900
Mailing Address - Fax:845-426-6926
Practice Address - Street 1:95 NEW CLARKSTOWN RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-5203
Practice Address - Country:US
Practice Address - Phone:845-426-6900
Practice Address - Fax:845-426-6926
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00013300222Z00000X, 224P00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01703433Medicaid
NY01703433Medicaid