Healthcare Provider Details

I. General information

NPI: 1629117759
Provider Name (Legal Business Name): URSZULA GRAZYNA BROZEK MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 OAK ST STE B
COPIAGUE NY
11726-3244
US

IV. Provider business mailing address

517 OAK ST STE B
COPIAGUE NY
11726-3244
US

V. Phone/Fax

Practice location:
  • Phone: 718-614-5149
  • Fax:
Mailing address:
  • Phone: 631-608-1866
  • Fax: 631-608-1867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021005-2
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: