Provider Demographics
NPI:1518021146
Name:BARAK, TZVI (PT)
Entity Type:Individual
Prefix:
First Name:TZVI
Middle Name:
Last Name:BARAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 66TH ST
Mailing Address - Street 2:APT. D704
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-9175
Mailing Address - Country:US
Mailing Address - Phone:917-734-3295
Mailing Address - Fax:
Practice Address - Street 1:1015 MADISON AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-0261
Practice Address - Country:US
Practice Address - Phone:212-772-6610
Practice Address - Fax:212-772-7804
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001915174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ51602Medicare ID - Type UnspecifiedPHYSICAL THERAPY