Provider Demographics
NPI:1659146546
Name:DZIEMIANKO, MARCIN PAWEL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:MARCIN
Middle Name:PAWEL
Last Name:DZIEMIANKO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:41 HAROLD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6210
Mailing Address - Country:US
Mailing Address - Phone:914-409-8059
Mailing Address - Fax:
Practice Address - Street 1:11 W 25TH ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2058
Practice Address - Country:US
Practice Address - Phone:212-308-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY050495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist