Provider Demographics
NPI:1063801595
Name:KAZMIERCZAK, ANNA (PT,DPT)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:KAZMIERCZAK
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-1634
Mailing Address - Country:US
Mailing Address - Phone:917-859-6549
Mailing Address - Fax:201-934-1241
Practice Address - Street 1:16 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:UPPER SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-1634
Practice Address - Country:US
Practice Address - Phone:917-859-6549
Practice Address - Fax:201-934-1241
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01552500225100000X
NY037396-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist