Provider Demographics
NPI:1073896957
Name:TEREKHOV AKA PERLOFF, ILYA (DPT)
Entity Type:Individual
Prefix:MR
First Name:ILYA
Middle Name:
Last Name:TEREKHOV AKA PERLOFF
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1659 78TH ST
Mailing Address - Street 2:SUITE# 2A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1011
Mailing Address - Country:US
Mailing Address - Phone:718-234-1212
Mailing Address - Fax:718-234-1164
Practice Address - Street 1:1659 78TH ST
Practice Address - Street 2:SUITE# 2A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1011
Practice Address - Country:US
Practice Address - Phone:718-234-1212
Practice Address - Fax:718-234-1164
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034342OtherLICENSE