Provider Demographics
NPI:1508122698
Name:PLVG PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PLVG PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLITO
Authorized Official - Middle Name:LYCURGOS VOCES
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-266-7700
Mailing Address - Street 1:15 BAY 29 STREET
Mailing Address - Street 2:3 A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214
Mailing Address - Country:US
Mailing Address - Phone:718-266-7700
Mailing Address - Fax:718-266-7100
Practice Address - Street 1:15 BAY 29 STREET
Practice Address - Street 2:3 A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214
Practice Address - Country:US
Practice Address - Phone:718-266-7700
Practice Address - Fax:718-266-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100067144Medicare PIN