Provider Demographics
NPI:1710371653
Name:GRAND REHAB PT PC
Entity Type:Organization
Organization Name:GRAND REHAB PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-863-8353
Mailing Address - Street 1:153 BAY 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4994
Mailing Address - Country:US
Mailing Address - Phone:347-702-9958
Mailing Address - Fax:347-710-7579
Practice Address - Street 1:153 BAY 26TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4994
Practice Address - Country:US
Practice Address - Phone:347-702-9958
Practice Address - Fax:347-507-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04869994Medicaid
NYA400016040Medicare PIN