Provider Demographics
NPI:1699229153
Name:ZDANOWICZ, EDWARD (PT,DPT)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:ZDANOWICZ
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10302-2049
Mailing Address - Country:US
Mailing Address - Phone:718-844-5350
Mailing Address - Fax:718-390-0067
Practice Address - Street 1:33 RICHMOND HILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5950
Practice Address - Country:US
Practice Address - Phone:718-982-6340
Practice Address - Fax:718-982-5358
Is Sole Proprietor?:No
Enumeration Date:2016-08-12
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist