Provider Demographics
NPI:1700225554
Name:SHCHERBAKOV, ANTON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:
Last Name:SHCHERBAKOV
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 HARING ST APT 6F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1818
Mailing Address - Country:US
Mailing Address - Phone:718-314-5139
Mailing Address - Fax:
Practice Address - Street 1:2455 HARING ST APT 6F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1818
Practice Address - Country:US
Practice Address - Phone:718-314-5139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist