| NPI | 1790110518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VITALY DVOSKIN Provider 917-604-8612 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 030873) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01328300) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: CA 36260) | |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2013-11-01 |