Basic Information
| Provider Information | |||||||||
| NPI: | 1154049021 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OGRODNIK | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | DERIAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16 MAYBROOK RD STE L | ||||||||
| Address2: | |||||||||
| City: | CAMPBELL HALL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109162741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456364344 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 BROOKSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109181003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454692224 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2022 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 049204 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.