Healthcare Provider Details

I. General information

NPI: 1972257541
Provider Name (Legal Business Name): NETHERLAND PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NETHERLAND AVE STE 121
BRONX NY
10463-4813
US

IV. Provider business mailing address

2600 NETHERLAND AVE STE 121
BRONX NY
10463-4813
US

V. Phone/Fax

Practice location:
  • Phone: 929-800-2011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: GLEB KARTSEV
Title or Position: MEMBER
Credential: PT
Phone: 929-800-2011