Healthcare Provider Details

I. General information

NPI: 1487807301
Provider Name (Legal Business Name): VLADISLAV KHLOPINE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 WEST AVE
NORWALK CT
06850-3302
US

IV. Provider business mailing address

2346 E 28TH ST
BROOKLYN NY
11229-5034
US

V. Phone/Fax

Practice location:
  • Phone: 203-855-3564
  • Fax:
Mailing address:
  • Phone: 718-715-9292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number039512
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008405
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: