MEDICARE: MS. IRINA DEKHTYAR PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	017716	NY

General Provider Information

NPI Number	:	1306052691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRINA DEKHTYAR PT

Provider Business Mailing Address
First Line	:	165 BAY 20TH ST APT 1C
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4667
Country	:	US
Telephone Number	:	718-621-2498
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 LENOX ROAD, BOX 30
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2098
Country	:	US
Telephone Number	:	718-270-2811
Fax Number	:	718-270-1247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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