Healthcare Provider Details

I. General information

NPI: 1104753615
Provider Name (Legal Business Name): SCOTT FRYCZYNSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BERDAN AVE STE 100
WAYNE NJ
07470-3236
US

IV. Provider business mailing address

139 CAMBRIDGE CT
CLIFTON NJ
07014-1323
US

V. Phone/Fax

Practice location:
  • Phone: 973-406-8060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01630400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: