Healthcare Provider Details

I. General information

NPI: 1730738402
Provider Name (Legal Business Name): JOHN BRUCE PUZIO PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

873 MAIN ST STE 2S
HACKENSACK NJ
07601-4930
US

IV. Provider business mailing address

873 MAIN ST STE 2S
HACKENSACK NJ
07601-4930
US

V. Phone/Fax

Practice location:
  • Phone: 201-290-4826
  • Fax: 201-643-6195
Mailing address:
  • Phone: 201-290-4826
  • Fax: 201-643-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01923000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number044758
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: