Provider Demographics
NPI:1700369782
Name:NIEZNALSKA, URSZULA (PT)
Entity Type:Individual
Prefix:
First Name:URSZULA
Middle Name:
Last Name:NIEZNALSKA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 MOUNT PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-1609
Mailing Address - Country:US
Mailing Address - Phone:201-543-8134
Mailing Address - Fax:
Practice Address - Street 1:39-40 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5419
Practice Address - Country:US
Practice Address - Phone:201-791-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01815200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist