Healthcare Provider Details

I. General information

NPI: 1881645687
Provider Name (Legal Business Name): MICHAEL URBANOWICZ PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 VANDERBILT AVE SUITE 1413
NEW YORK NY
10017-3808
US

IV. Provider business mailing address

194 MAIN ST
MILLBURN NJ
07041-1144
US

V. Phone/Fax

Practice location:
  • Phone: 212-599-0099
  • Fax: 212-599-0389
Mailing address:
  • Phone: 973-564-9559
  • Fax: 973-564-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberQA02948
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: