Provider Demographics
NPI:1558445155
Name:DUSSMAN, DANIEL J (PT CHT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:J
Last Name:DUSSMAN
Suffix:
Gender:M
Credentials:PT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 32ND ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087
Mailing Address - Country:US
Mailing Address - Phone:201-601-0303
Mailing Address - Fax:201-601-8040
Practice Address - Street 1:584 32ND ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087
Practice Address - Country:US
Practice Address - Phone:201-601-0303
Practice Address - Fax:201-601-8040
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQAO3536225100000X
NJQA035362251H1200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1093910325OtherGROUP NPI
NJ11495500OtherACS
NJHS084OtherOXFORD
NJ805683OtherUNITED HEALTH CARE
NJ142070002OtherUNIVERSITY HEALTH PLANS
NJ5689468OtherAETNA
NJ805683OtherUNITED HEALTH CARE