Individual provider Active NPI

Brandon Dziedzic

  • Physical Therapist
  • Staten Island, NY
National Provider Identifier
1053911461
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
046288 Issued in NY
Practice address
1415 Richmond Ave
Staten Island, NY 10314-1553
Phone
(877) 407-3422
Fax
(877) 407-4329
NPI assigned
Oct 27, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 046288 NY Primary

Addresses

Primary practice location

1415 Richmond Ave
Staten Island, NY 10314-1553

Mailing address

7 Carnegie PLZ
Cherry Hill, NJ 08003-1000
Phone (877) 407-3422

Other practice location 1

475 Northern Blvd Ste 11
Great Neck, NY 11021-4802
Phone (516) 829-0030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201109002371 NY Practitioner - Physical Therapist in Private Practice 8921418625 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physical Therapy Services of Flatiron PCGroup PAC ID 1759784085, 112 clinicians
Reddy Care Physical Therapy PCGroup PAC ID 5890685986, 139 clinicians

Practice addresses (Care Compare)

138 5TH Ave
FL 2
New York, NY 10011-4367
Phone (212) 287-4257

475 Northern Blvd
Great Neck, NY 11021-4802
Phone (516) 829-0030

800 E Gate Blvd
Garden City, NY 11530-2105
Phone (516) 745-8070

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
In-Motion Physical Therapy, P.C. CurrentSince Dec 1, 2024 Accepting new patients
Reddy Care Physical Therapy PC Physical Therapist CurrentSince Mar 10, 2026 Accepting new patients
Physical Therapy Services of Flatiron PC Physical Therapist CurrentSince May 16, 2025 Accepting new patients
Fox Rehabilitation Physical Therapy Services LLC Physical Therapist CurrentSince Nov 1, 2020 Accepting new patients
Metro Physical Occupational Speech Massage Therapy & Acupuncture PLLC Physical Therapist CurrentSince Apr 1, 2025 Accepting new patients
In-Motion Physical Therapy PC CurrentSince Dec 1, 2024 Accepting new patients

Locations

7 Carnegie Plz
Cherry Hill, NJ 08003

805 Broadway
Ste 100
Amityville, NY 11701
Phone (631) 608-8874

309 Northwest Dr
Farmingdale, NY 11735
Phone (516) 420-2900

27278 Grand Central Pkwy
Floral Park, NY 11005
Phone (516) 344-0030

800 E Gate Blvd
Garden City, NY 11530

475 Northern Blvd
Ste 11
Great Neck, NY 11021
Phone (516) 344-0023

50 Glen Cove Rd
Greenvale, NY 11548
Phone (516) 200-3545

138 5th Ave
Fl 2
New York, NY 10011
Phone (212) 287-4257

11701 84th Ave
Richmond Hill, NY 11418
Phone (718) 441-0300

1415 Richmond Ave
Staten Island, NY 10314
Phone (212) 475-5540

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1053911461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 CARNEGIE PLZ",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080031000",
            "telephone_number": "877-407-3422",
            "fax_number": "877-407-4329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 RICHMOND AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103141553",
            "telephone_number": "877-407-3422",
            "fax_number": "877-407-4329"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Northern Blvd Ste 11",
            "address_purpose": "LOCATION",
            "city": "Great Neck",
            "state": "NY",
            "postal_code": "110214802",
            "country_code": "US",
            "telephone_number": "516-829-0030",
            "fax_number": "516-466-7723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DZIEDZIC",
        "first_name": "BRANDON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-10-27",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "046288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.