Provider Demographics
NPI:1710205174
Name:ONEFATOR, YEVGENY (DPT)
Entity Type:Individual
Prefix:
First Name:YEVGENY
Middle Name:
Last Name:ONEFATOR
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2665 HOMECREST AVE APT 2L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4533
Mailing Address - Country:US
Mailing Address - Phone:171-875-3036
Mailing Address - Fax:
Practice Address - Street 1:186 JORALEMON ST FL 8
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4326
Practice Address - Country:US
Practice Address - Phone:718-858-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist