Basic Information
| Provider Information | |||||||||
| NPI: | 1063641132 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DATU | ||||||||
| FirstName: | ADRIAN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT, PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 EARLE OVINGTON BLVD | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | UNIONDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115533610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163212400 | ||||||||
| FaxNumber: | 5163212424 | ||||||||
| Practice Location | |||||||||
| Address1: | 723 SEVENTH AVE | ||||||||
| Address2: | 9TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100196832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123159578 | ||||||||
| FaxNumber: | 2123159586 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2009 | ||||||||
| LastUpdateDate: | 07/22/2014 | ||||||||
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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 | 40QA01316900 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 23540 | MD | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.