Healthcare Provider Details

I. General information

NPI: 1407331044
Provider Name (Legal Business Name): TERESA IODICE-DADIN MA, PT, CCTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2018
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 1ST AVE
NEW YORK NY
10003-2914
US

IV. Provider business mailing address

333 E 38TH ST
NEW YORK NY
10016-2772
US

V. Phone/Fax

Practice location:
  • Phone: 646-501-7077
  • Fax:
Mailing address:
  • Phone: 646-501-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number008753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: