MEDICARE: IRINA MESHERIAKOV PT 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	:	1760125835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRINA MESHERIAKOV PT PC

Provider Business Mailing Address
First Line	:	848 EDGEGROVE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	848 EDGEGROVE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2407
Country	:	US
Telephone Number	:	917-660-3776
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	IRINA MESHERIAKOV
Credential	:
Telephone Number	:	917-660-3776

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	04/18/2022

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