Healthcare Provider Details

I. General information

NPI: 1497121081
Provider Name (Legal Business Name): MICHAEL J KUZNIEWSKI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 WANTAGH AVE SUITE 2
LEVITTOWN NY
11756-5390
US

IV. Provider business mailing address

650 WANTAGH AVE SUITE 2
LEVITTOWN NY
11756-5390
US

V. Phone/Fax

Practice location:
  • Phone: 516-520-7200
  • Fax:
Mailing address:
  • Phone: 516-520-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number039265
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: