Provider Demographics
NPI:1740650944
Name:HADDICAN, EDWARD JOSEPH (PT, DPT, OCS)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:HADDICAN
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HAWK ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2811
Mailing Address - Country:US
Mailing Address - Phone:845-642-9834
Mailing Address - Fax:
Practice Address - Street 1:71 CARROLL ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-2767
Practice Address - Country:US
Practice Address - Phone:718-797-9797
Practice Address - Fax:718-797-9796
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist