Healthcare Provider Details

I. General information

NPI: 1902428717
Provider Name (Legal Business Name): VIKTORIYA KULYK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 MAIN ST
FLUSHING NY
11355-3833
US

IV. Provider business mailing address

214 9TH ST
HICKSVILLE NY
11801-5446
US

V. Phone/Fax

Practice location:
  • Phone: 917-602-5414
  • Fax: 718-732-1307
Mailing address:
  • Phone: 917-602-5414
  • Fax: 718-732-1307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number053252
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: