Provider Demographics
NPI:1710909668
Name:TELACKI, WOJCIECH (MSPT)
Entity Type:Individual
Prefix:
First Name:WOJCIECH
Middle Name:
Last Name:TELACKI
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 NORTHERN BLVD STE 311
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5329
Mailing Address - Country:US
Mailing Address - Phone:516-365-8215
Mailing Address - Fax:516-365-8296
Practice Address - Street 1:1010 NORTHERN BLVD STE 406
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5330
Practice Address - Country:US
Practice Address - Phone:516-365-8215
Practice Address - Fax:516-365-8296
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022886225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist