Provider Demographics
NPI:1629775556
Name:PILOSOV, IOSIF
Entity Type:Individual
Prefix:
First Name:IOSIF
Middle Name:
Last Name:PILOSOV
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 1:9826 64TH AVE APT 8D
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2508
Mailing Address - Country:US
Mailing Address - Phone:917-704-4380
Mailing Address - Fax:
Practice Address - Street 1:7649 HEWLETT ST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1429
Practice Address - Country:US
Practice Address - Phone:212-388-1903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0000000000000OtherFEDELIS