MEDICARE: ALEKSANDR GONCHAROV P.T.

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	33232	NY

General Provider Information

NPI Number	:	1467752865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEKSANDR GONCHAROV P.T.

Provider Business Mailing Address
First Line	:	2530 OCEAN AVE APT 1D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3928
Country	:	US
Telephone Number	:	347-784-4530
Fax Number	:	347-673-7904

Provider Business Practice Location Address
First Line	:	1702 AVENUE Z APT 5B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-3657
Country	:	US
Telephone Number	:	347-784-4530
Fax Number	:	347-673-7904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	09/10/2020

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