Provider Demographics
NPI:1053925982
Name:WISNEWSKI, ROBERT (DPT)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:WISNEWSKI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4607
Mailing Address - Country:US
Mailing Address - Phone:516-326-7899
Mailing Address - Fax:
Practice Address - Street 1:1204 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4607
Practice Address - Country:US
Practice Address - Phone:516-326-7899
Practice Address - Fax:516-326-7895
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist