Healthcare Provider Details

I. General information

NPI: 1053854059
Provider Name (Legal Business Name): BRIGHT START PT & PTA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2016
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OCEAN VIEW AVE
BROOKLYN NY
11235
US

IV. Provider business mailing address

301 OCEAN VIEW AVE
BROOKLYN NY
11235-6826
US

V. Phone/Fax

Practice location:
  • Phone: 929-371-2131
  • Fax:
Mailing address:
  • Phone: 929-371-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number023288
License Number StateNY

VIII. Authorized Official

Name: BORIS DOLUB
Title or Position: DIRECTOR
Credential: PHYSICAL THERAPIST
Phone: 929-371-2131