Healthcare Provider Details

I. General information

NPI: 1467641209
Provider Name (Legal Business Name): GRZEGORZ WOLSKI PT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7002 FRESH POND RD
RIDGEWOOD NY
11385-5902
US

IV. Provider business mailing address

11115 75TH AVE SUITE 40
FOREST HILLS NY
11375-6327
US

V. Phone/Fax

Practice location:
  • Phone: 718-381-3373
  • Fax: 718-381-3378
Mailing address:
  • Phone: 917-723-5824
  • Fax: 718-575-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023168
License Number StateNY

VIII. Authorized Official

Name: GRZEGORZ WOLSKI
Title or Position: PRESIDENT
Credential: PT
Phone: 917-723-5824