Provider Demographics
NPI:1679506380
Name:SKLAROV, SERGEY (LMT)
Entity Type:Individual
Prefix:MR
First Name:SERGEY
Middle Name:
Last Name:SKLAROV
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 PARK PL
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3735
Mailing Address - Country:US
Mailing Address - Phone:201-290-6573
Mailing Address - Fax:
Practice Address - Street 1:421 PARK PL
Practice Address - Street 2:SUITE 1-C
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3735
Practice Address - Country:US
Practice Address - Phone:201-290-6573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00327300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSS1049462OtherASHN PROVIDER.
NJP3664355OtherOXFORD CAM PROVIDER