Provider Demographics
NPI:1154394203
Name:FIORDALISI, GERARD (PT)
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:
Last Name:FIORDALISI
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 1:8 MCGUINNESS BLVD S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4997
Mailing Address - Country:US
Mailing Address - Phone:718-389-3131
Mailing Address - Fax:718-389-0625
Practice Address - Street 1:8 MCGUINNESS BLVD S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-4997
Practice Address - Country:US
Practice Address - Phone:718-389-3131
Practice Address - Fax:718-389-0625
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6109225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02018871Medicaid
NY02018871Medicaid
S39553Medicare UPIN