Provider Demographics
NPI:1275057242
Name:GERSHTEYN, VIKTORIYA (PTA)
Entity Type:Individual
Prefix:MS
First Name:VIKTORIYA
Middle Name:
Last Name:GERSHTEYN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 SAINT CLOUD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2519
Mailing Address - Country:US
Mailing Address - Phone:973-525-5838
Mailing Address - Fax:
Practice Address - Street 1:1111 CLIFTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3633
Practice Address - Country:US
Practice Address - Phone:973-400-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00341300225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant