Provider Demographics
NPI:1528042900
Name:PAWLOWSKI, JOHN ROBERT (PT, MHS, OCS, CWCE)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROBERT
Last Name:PAWLOWSKI
Suffix:
Gender:M
Credentials:PT, MHS, OCS, CWCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WATER FRONT VW
Mailing Address - Street 2:
Mailing Address - City:MOHEGAN LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:10547-1214
Mailing Address - Country:US
Mailing Address - Phone:914-526-4783
Mailing Address - Fax:914-526-4783
Practice Address - Street 1:280 DOBBS FERRY RD
Practice Address - Street 2:209
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1900
Practice Address - Country:US
Practice Address - Phone:914-428-9698
Practice Address - Fax:914-428-6013
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014210-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL5821Medicare ID - Type Unspecified