Healthcare Provider Details

I. General information

NPI: 1306155254
Provider Name (Legal Business Name): JOSEPH BENJAMIN MORDUS PT, DPT,MPH, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ECHO RD
SHERMAN CT
06784-2508
US

IV. Provider business mailing address

4 ECHO RD
SHERMAN CT
06784-2508
US

V. Phone/Fax

Practice location:
  • Phone: 860-237-5511
  • Fax: 860-207-8005
Mailing address:
  • Phone: 860-237-5511
  • Fax: 860-207-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number033098-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: