Provider Demographics
NPI:1164515581
Name:KATSNELSON, YEVGENY (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:YEVGENY
Middle Name:
Last Name:KATSNELSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:MR
Other - First Name:EUGENE
Other - Middle Name:
Other - Last Name:KATSNELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:21 HALCO DR
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4625
Mailing Address - Country:US
Mailing Address - Phone:201-468-0282
Mailing Address - Fax:201-431-1101
Practice Address - Street 1:15-01 POLLITT DR STE 3
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2769
Practice Address - Country:US
Practice Address - Phone:201-468-0282
Practice Address - Fax:201-431-1101
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA1159600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist