Provider Demographics
NPI:1275994519
Name:PESKOVA, YEVGENIYA (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:
Last Name:PESKOVA
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 ROUTE 9
Mailing Address - Street 2:UNIT A10
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-5107
Mailing Address - Country:US
Mailing Address - Phone:732-860-8100
Mailing Address - Fax:732-860-8101
Practice Address - Street 1:335 ROUTE 9
Practice Address - Street 2:UNIT A10
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-5107
Practice Address - Country:US
Practice Address - Phone:732-860-8100
Practice Address - Fax:732-860-8101
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00702800225X00000X
NY019788-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100153269OtherMEDICARE PTAN