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NPI Code Detail

MEDICARE: ARTEM KOVYAZIN PT,DPT

MEDICARE: ARTEM KOVYAZIN PT,DPT
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
1225100000XPhysical Therapist045283NY

General Provider Information

NPI Number : 1922644517
Entity Type Code : Individual
Provider Name (Legal Business Name) : ARTEM KOVYAZIN PT,DPT
Provider Business Mailing Address
First Line : 900 ROUTE 9 N
Second Line :
City : WOODBRIDGE
State : NJ
Zip : 07095-1025
Country : US
Telephone Number : 201-801-7141
Fax Number :
Provider Business Practice Location Address
First Line : 2148 OCEAN AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-1483
Country : US
Telephone Number : 718-872-7002
Fax Number : 718-872-6899
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2019
Last Update Date : 11/19/2019

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