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General NPI Number Information
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NPI Number | 1881937423
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Entity Type | Organization
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Legal Business Name | AVANTGARDE REHABILITATION LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 04/02/2013
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 520 BLOOMINGDALE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2061
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Country | US
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Telephone | 718-605-1300
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Fax | 718-605-8739
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Provider Business Mailing Address
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Address Line | 8 BUR CT
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City | MANALAPAN
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State | NJ
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Zip | 07726-1878
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Country | US
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Telephone | 732-995-9293
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIKTORIYA KHOMENKO
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Credential | DPT
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Telephone | 718-605-1300
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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 | 8002032
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License Number State | NY
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