Basic Information
| Provider Information | |||||||||
| NPI: | 1013978774 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZAVODSKY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 WALTON ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132021230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154780380 | ||||||||
| FaxNumber: | 3154780388 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 RACQUET RD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | NEWBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125505705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455679462 | ||||||||
| FaxNumber: | 8455679493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 027073 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.