Provider Demographics
NPI:1851491971
Name:WYSZYNSKI, MAREK B (PT)
Entity Type:Individual
Prefix:MR
First Name:MAREK
Middle Name:B
Last Name:WYSZYNSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 E 49TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1607
Mailing Address - Country:US
Mailing Address - Phone:646-497-1480
Mailing Address - Fax:646-497-1459
Practice Address - Street 1:338 E 49TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1607
Practice Address - Country:US
Practice Address - Phone:646-497-1480
Practice Address - Fax:646-497-1459
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014971225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL7601Medicare PIN