Provider Demographics
NPI:1427336197
Name:DIMITRIADIS, DEMETRI (PT, DPT)
Entity type:Individual
Prefix:
First Name:DEMETRI
Middle Name:
Last Name:DIMITRIADIS
Suffix:
Gender:M
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 1:56 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:HAWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07641-1450
Mailing Address - Country:US
Mailing Address - Phone:201-588-6290
Mailing Address - Fax:201-588-6059
Practice Address - Street 1:100 UNION AVE STE 200
Practice Address - Street 2:
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2137
Practice Address - Country:US
Practice Address - Phone:201-588-6290
Practice Address - Fax:201-588-6059
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01409300225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic