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General NPI Number Information
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NPI Number | 1205073897
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Entity Type | Individual
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Provider Name | VITALY DVOSKIN DPT
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Gender | Male
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Dates
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Enumeration Date | 01/19/2009
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 605 MADISON AVE 4TH FLOOR/JFGYMNASTIQUE
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City | NEW YORK
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State | NY
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Zip | 10022-1900
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Country | US
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Telephone | 888-705-2227
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Fax | 888-705-2297
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Provider Business Mailing Address
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Address Line | 116 E 60TH ST SUITE 1002
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City | NEW YORK
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State | NY
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Zip | 10022-1107
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Country | US
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Telephone | 917-604-8612
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Fax | 917-604-8612
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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 | 030873
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License Number State | NY
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