Provider Demographics
NPI:1952777260
Name:WNUKOWSKI, MARK J (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:WNUKOWSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 W 35TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-2505
Mailing Address - Country:US
Mailing Address - Phone:212-453-0036
Mailing Address - Fax:212-453-0037
Practice Address - Street 1:248 W 35TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2505
Practice Address - Country:US
Practice Address - Phone:212-453-0036
Practice Address - Fax:212-453-0037
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist