Healthcare Provider Details

I. General information

NPI: 1578592747
Provider Name (Legal Business Name): VLADIMIR TOKAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 SHORE FRONT PKWY APT. 11N
ROCKAWAY BEACH NY
11693-1607
US

IV. Provider business mailing address

8400 SHORE FRONT PKWY APT 11N
ROCKAWAY BEACH NY
11693-1822
US

V. Phone/Fax

Practice location:
  • Phone: 718-380-0555
  • Fax: 718-380-1511
Mailing address:
  • Phone: 718-380-0555
  • Fax: 718-380-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018829
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: