Provider Demographics
NPI:1790188316
Name:GRASMERE PHYSICAL THERAPY AND REHABILITATION, PLLC
Entity Type:Organization
Organization Name:GRASMERE PHYSICAL THERAPY AND REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:TSERLYUK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-442-1003
Mailing Address - Street 1:684 W FINGERBOARD RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2630
Mailing Address - Country:US
Mailing Address - Phone:718-442-1003
Mailing Address - Fax:718-442-1150
Practice Address - Street 1:684 W FINGERBOARD RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2630
Practice Address - Country:US
Practice Address - Phone:718-442-1003
Practice Address - Fax:718-442-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-28
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy