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General NPI Number Information
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NPI Number | 1447405709
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Entity Type | Individual
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Provider Name | MS. YOLANDA GERASIMOVICH
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Gender | Female
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Dates
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Enumeration Date | 11/28/2008
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Last Update Date | 06/15/2011
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Provider Practice Location Address
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Address Line | 538 BROAD HOLLOW RD SUITE 202
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City | MELVILLE
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State | NY
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Zip | 11747
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Country | US
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Telephone | 516-812-8456
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Fax |
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Provider Business Mailing Address
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Address Line | 34-65 192ND ST
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City | FLUSHING
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State | NY
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Zip | 11358
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Country | US
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Telephone | 516-554-1799
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Fax |
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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 | 010817
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 010817-1
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License Number State | NY
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