Provider Demographics
NPI:1578592747
Name:TOKAR, VLADIMIR
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:TOKAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 SHORE FRONT PKWY APT 11N
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11693-1822
Mailing Address - Country:US
Mailing Address - Phone:718-380-0555
Mailing Address - Fax:718-380-1511
Practice Address - Street 1:8400 SHORE FRONT PKWY APT. 11N
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693-1607
Practice Address - Country:US
Practice Address - Phone:718-380-0555
Practice Address - Fax:718-380-1511
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018829225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02088388Medicaid
NY06603GOtherMEDICARE
NY02088388Medicaid
NY06603GOtherMEDICARE