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General NPI Number Information
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NPI Number | 1134847585
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Entity Type | Organization
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Legal Business Name | KRASILOVSKY NY PT PLLC
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 35 E 35TH ST RM 206A
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City | NEW YORK
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State | NY
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Zip | 10016-3823
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Country | US
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Telephone | 231-564-6389
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Fax |
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Provider Business Mailing Address
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Address Line | 991 US HIGHWAY 22 STE 200
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City | BRIDGEWATER
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State | NJ
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Zip | 08807-2957
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Country | US
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Telephone | 231-564-6389
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Fax |
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Authorized Official
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Title or Position | OWNER/PT
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Name | GARY KRASILOVSKY
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Credential | PT
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Telephone | 203-451-3643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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