MEDICARE: MY NYC PHYSICAL THERAPY PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1336006931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY NYC PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	14429 78TH AVE FL 1
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-3430
Country	:	US
Telephone Number	:	917-670-8258
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 E TREMONT AVE STE 204
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-0380
Country	:	US
Telephone Number	:	347-293-7600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MOSHIAH YAKUBOV
Credential	:	DPT
Telephone Number	:	917-670-8258

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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