Provider Demographics
NPI:1710910112
Name:POLONSKIY, BORIS (DPT)
Entity Type:Individual
Prefix:MR
First Name:BORIS
Middle Name:
Last Name:POLONSKIY
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 1:1835 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2560
Mailing Address - Country:US
Mailing Address - Phone:718-502-5271
Mailing Address - Fax:718-701-1188
Practice Address - Street 1:1835 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2560
Practice Address - Country:US
Practice Address - Phone:718-502-5271
Practice Address - Fax:718-701-1188
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38484225100000X
NJ40QA01591600225100000X
NY028006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q31R81Medicare ID - Type Unspecified