Provider Demographics
NPI:1376630905
Name:FIRST CLASS PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:FIRST CLASS PHYSICAL THERAPY, P.C.
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:718-996-1100
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:718-996-1100
Mailing Address - Fax:718-676-9511
Practice Address - Street 1:3514 MERMAID AVE
Practice Address - Street 2:SUITE 003
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1508
Practice Address - Country:US
Practice Address - Phone:718-996-1100
Practice Address - Fax:718-676-9511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019225225100000X
NY028641225100000X
NY018570225100000X
NY032358225100000X
NY032340225100000X
NY031898225100000X
NY032531225100000X
NY033556225100000X
NY030156225100000X
NY035869225100000X
NY036226225100000X
NY005486225200000X
NY005573225200000X
NY005550225200000X
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
NY02186065Medicaid
NYQ4W9R1Medicare ID - Type Unspecified
NY02186065Medicaid