MEDICARE: MICHAEL BARANOV 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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A100123733	OTHER	NY	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467496679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL BARANOV PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	15611 AGUILAR AVE # 1018
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11367-2732
Country	:	US
Telephone Number	:	718-975-3515
Fax Number	:	718-975-3514

Provider Business Practice Location Address
First Line	:	4119 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5709
Country	:	US
Telephone Number	:	718-975-3515
Fax Number	:	718-975-3514

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL BARANOV
Credential	:	PT
Telephone Number	:	718-975-3515

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	10/18/2021

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