Provider Demographics
NPI:1881788255
Name:PREUSS, MARTIN (PT)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:PREUSS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:MARCIN
Other - Middle Name:J
Other - Last Name:PREUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1 RYKOWSKI LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4019
Mailing Address - Country:US
Mailing Address - Phone:845-692-2225
Mailing Address - Fax:845-692-2239
Practice Address - Street 1:1 RYKOWSKI LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4019
Practice Address - Country:US
Practice Address - Phone:845-692-2225
Practice Address - Fax:845-692-2239
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019254-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q27V61Medicare ID - Type Unspecified