Healthcare Provider Details

I. General information

NPI: 1003480757
Provider Name (Legal Business Name): EDMUND FALKOWSKI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 OLD MILITARY RD
LAKE PLACID NY
12946-1738
US

IV. Provider business mailing address

203 OLD MILITARY RD
LAKE PLACID NY
12946-1738
US

V. Phone/Fax

Practice location:
  • Phone: 518-523-8580
  • Fax:
Mailing address:
  • Phone: 518-523-8580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number045934
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: