Provider Demographics
NPI:1124236336
Name:GAZDZINSKI, ADAM T (DPT, ECS, OCS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:T
Last Name:GAZDZINSKI
Suffix:
Gender:M
Credentials:DPT, ECS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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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:646-918-7816
Mailing Address - Fax:201-731-5533
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:646-918-7816
Practice Address - Fax:646-661-2151
Is Sole Proprietor?:No
Enumeration Date:2007-05-19
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225100000X
NY0218372251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02231652Medicaid
NY02231652Medicaid