Provider Demographics
NPI:1265892251
Name:NORTHERN MANHATTAN PHYSICAL THERAPY AND CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:NORTHERN MANHATTAN PHYSICAL THERAPY AND CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZDZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ECS, OCS
Authorized Official - Phone:646-863-8353
Mailing Address - Street 1:651 W 180TH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4802
Mailing Address - Country:US
Mailing Address - Phone:646-918-7810
Mailing Address - Fax:646-661-2151
Practice Address - Street 1:651 W 180TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4802
Practice Address - Country:US
Practice Address - Phone:646-918-7810
Practice Address - Fax:646-661-2151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111N00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05625961Medicaid