Provider Demographics
NPI:1134289796
Name:IVASHENKO, ALEX (PT DPT)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:IVASHENKO
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 ROUTE 27
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817
Mailing Address - Country:US
Mailing Address - Phone:732-777-9733
Mailing Address - Fax:732-777-9730
Practice Address - Street 1:2147 ROUTE 27
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817
Practice Address - Country:US
Practice Address - Phone:732-777-9733
Practice Address - Fax:732-777-9730
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA002797002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic