Provider Demographics
NPI:1164675336
Name:BASHKINA, OLGA V (PTBS)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:V
Last Name:BASHKINA
Suffix:
Gender:F
Credentials:PTBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3107
Mailing Address - Country:US
Mailing Address - Phone:718-921-1020
Mailing Address - Fax:718-921-1020
Practice Address - Street 1:371 BAY RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3107
Practice Address - Country:US
Practice Address - Phone:718-921-1020
Practice Address - Fax:718-921-1020
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-31
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03055974Medicaid
NY03055974Medicaid