Provider Demographics
NPI:1598713323
Name:GROMELSKI, STANLEY JASON (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:JASON
Last Name:GROMELSKI
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
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Mailing Address - Street 1:2 W 45TH ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4212
Mailing Address - Country:US
Mailing Address - Phone:212-840-6652
Mailing Address - Fax:212-840-6022
Practice Address - Street 1:2 W 45TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4212
Practice Address - Country:US
Practice Address - Phone:212-840-6652
Practice Address - Fax:212-840-6022
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY022090225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400001032Medicare PIN