Provider Demographics
NPI:1467496679
Name:MICHAEL BARANOV PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MICHAEL BARANOV PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BARANOV
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-975-3515
Mailing Address - Street 1:15611 AGUILAR AVE # 1018
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2732
Mailing Address - Country:US
Mailing Address - Phone:718-975-3515
Mailing Address - Fax:718-975-3514
Practice Address - Street 1:4119 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5709
Practice Address - Country:US
Practice Address - Phone:718-975-3515
Practice Address - Fax:718-975-3514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100123733OtherMEDICARE
NY03356723Medicaid
NYQ4W6G1Medicare PIN
NYQB7051Medicare PIN
NYA400001134Medicare PIN