=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033721311
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH RUSZKOWSKI DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2020
-----------------------------------------------------
Last Update Date | 10/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 ELLIS ST
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10307-1118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-439-3052
-----------------------------------------------------
Fax | 888-686-2968
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 194 MCBAINE AVE SIDE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10309-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-439-3052
-----------------------------------------------------
Fax | 888-686-2968
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 40QA01948600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 047135
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------