Provider Demographics
NPI:1154197994
Name:JODUSH, NICHOLAS STEPHEN (PT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:STEPHEN
Last Name:JODUSH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1559
Mailing Address - Country:US
Mailing Address - Phone:716-790-1599
Mailing Address - Fax:
Practice Address - Street 1:815 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-2320
Practice Address - Country:US
Practice Address - Phone:716-688-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist