Provider Demographics
NPI:1225274228
Name:FIRST CLASS PHYSICAL THERAPY SERVICES OF NY, PC
Entity Type:Organization
Organization Name:FIRST CLASS PHYSICAL THERAPY SERVICES OF NY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHROMCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-207-7262
Mailing Address - Street 1:11 HEDGEROW LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-7905
Mailing Address - Country:US
Mailing Address - Phone:347-843-8008
Mailing Address - Fax:347-843-8009
Practice Address - Street 1:799 E GUN HILL RD
Practice Address - Street 2:CELLAR FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6107
Practice Address - Country:US
Practice Address - Phone:347-843-8008
Practice Address - Fax:347-843-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028641225100000X
NY019225225100000X
NY032531225100000X
NY030156225100000X
NY008315225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03295847Medicaid
NYA100001653Medicare PIN