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General NPI Number Information
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NPI Number | 1699438580
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Entity Type | Individual
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Provider Name | IRYNA O OLEKSYUK PTA
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Gender | Female
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Dates
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Enumeration Date | 10/18/2021
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 220 CENTENNIAL AVE
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City | PISCATAWAY
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State | NJ
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Zip | 08854-3940
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Country | US
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Telephone | 201-941-8008
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Fax |
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Provider Business Mailing Address
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Address Line | 26 JUDSON ST APT 10B
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City | EDISON
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State | NJ
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Zip | 08837-2431
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Country | US
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Telephone | 914-733-2181
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00369400
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License Number State | NJ
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