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General NPI Number Information
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NPI Number | 1023470093
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Entity Type | Individual
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Provider Name | VLADIMIR FEDOSSEEV PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 3371 RICHMOND AVE LOWR LEVEL
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City | STATEN ISLAND
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State | NY
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Zip | 10312-2025
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Country | US
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Telephone | 718-808-9337
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Fax | 347-983-6126
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Provider Business Mailing Address
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Address Line | 3371 RICHMOND AVE LOWR LEVEL
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City | STATEN ISLAND
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State | NY
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Zip | 10312-2025
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Country | US
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Telephone | 718-808-9337
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Fax | 347-983-6126
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 038352-1
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License Number State | NY
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