Healthcare Provider Details

I. General information

NPI: 1205741238
Provider Name (Legal Business Name): STANISLAV KUPCHENKO PT DPT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W 39TH ST FL 2
NEW YORK NY
10018-3834
US

IV. Provider business mailing address

40 W 39TH ST FL 2
NEW YORK NY
10018-3834
US

V. Phone/Fax

Practice location:
  • Phone: 347-686-5250
  • Fax: 212-223-0198
Mailing address:
  • Phone: 347-686-5250
  • Fax: 212-223-0198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: STANISLAV KUPCHENKO
Title or Position: PRESIDENT
Credential: PT
Phone: 347-686-5250