Provider Demographics
NPI:1225152408
Name:PHYSICAL THERAPY RESINST, PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY RESINST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIANOVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-232-7778
Mailing Address - Street 1:7803 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1207
Mailing Address - Country:US
Mailing Address - Phone:718-232-7778
Mailing Address - Fax:718-232-9634
Practice Address - Street 1:7803 20TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1207
Practice Address - Country:US
Practice Address - Phone:718-232-7778
Practice Address - Fax:718-232-9634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0108401OtherHEALTH NET
NY02195779Medicaid
NYQYW13OtherEMPIRE BC&BS
NY02195779Medicaid