Provider Demographics
NPI:1407178684
Name:NETIS, IGOR (DPT)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:NETIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2279 CONEY ISLAND AVE AVE
Mailing Address - Street 2:SUITE #2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3337
Mailing Address - Country:US
Mailing Address - Phone:718-998-9890
Mailing Address - Fax:718-998-9891
Practice Address - Street 1:2279 CONEY ISLAND AVE AVE
Practice Address - Street 2:SUITE #2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3337
Practice Address - Country:US
Practice Address - Phone:718-998-9890
Practice Address - Fax:718-998-9891
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032323208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation