Provider Demographics
NPI:1043562937
Name:PROSOLUTION REHAB SERVICES OT PT PLLC
Entity Type:Organization
Organization Name:PROSOLUTION REHAB SERVICES OT PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:B
Authorized Official - Last Name:YAGUDAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:201-916-8442
Mailing Address - Street 1:100 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3343
Mailing Address - Country:US
Mailing Address - Phone:201-916-8442
Mailing Address - Fax:516-616-0232
Practice Address - Street 1:100 CHERRY ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3343
Practice Address - Country:US
Practice Address - Phone:201-916-8442
Practice Address - Fax:516-616-0232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty