Active NPI
Daniel J Dziadura, PT
- Physical Therapist
- Brooklyn, NY
National Provider Identifier
1104846617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 015913
- Practice address
- 150 55 Street
Lutheran Medical Center Physician'S Faculty Practice
Brooklyn, NY 11220 - Phone
- (718) 630-8445
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 015913 | NY | Primary |
Addresses
Primary practice location
150 55 Street
Lutheran Medical Center Physician'S Faculty Practice
Brooklyn, NY 11220
Mailing address
1228 64TH St
Apt. a
Brooklyn, NY 11219-5377
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015913 | NY | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| LMC Physician Services, PC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104846617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1228 64TH ST",
"address_2": "APT. A",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112195377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 55 STREET",
"address_2": "LUTHERAN MEDICAL CENTER PHYSICIAN'S FACULTY PRACTICE",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "11220",
"telephone_number": "718-630-8445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DZIADURA",
"first_name": "DANIEL",
"middle_name": "J",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "015913",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.