Provider Demographics
NPI:1477605632
Name:PASKIEWICZ, SCOTT L (PT)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:PASKIEWICZ
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 1:679 WHISKEY RD
Mailing Address - Street 2:LEISURE PHYSICAL THERAPY
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961
Mailing Address - Country:US
Mailing Address - Phone:631-821-8090
Mailing Address - Fax:631-821-8366
Practice Address - Street 1:679 WHISKEY RD
Practice Address - Street 2:LEISURE PHYSICAL THERAPY
Practice Address - City:RIDGE
Practice Address - State:NY
Practice Address - Zip Code:11961-8352
Practice Address - Country:US
Practice Address - Phone:631-821-8090
Practice Address - Fax:631-821-8366
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016275-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL0381Medicare ID - Type Unspecified