Provider Demographics
NPI: | 1831134634 |
---|---|
Name: | SONEVYTSKY, MARKIAN L (PT) |
Entity Type: | Individual |
Prefix: | |
First Name: | MARKIAN |
Middle Name: | L |
Last Name: | SONEVYTSKY |
Suffix: | |
Gender: | M |
Credentials: | PT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 1180 RARITAN RD |
Mailing Address - Street 2: | PO BOX 1014 |
Mailing Address - City: | CLARK |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 07066-1311 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 732-855-9751 |
Mailing Address - Fax: | 732-855-9755 |
Practice Address - Street 1: | 3276 WASHINGTON RD |
Practice Address - Street 2: | |
Practice Address - City: | PARLIN |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08859-1676 |
Practice Address - Country: | US |
Practice Address - Phone: | 732-238-8484 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-17 |
Last Update Date: | 2015-01-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 0040QA00956500 | 2251E1200X, 2251G0304X, 2251H1300X, 2251N0400X, 2251P0200X, 2251S0007X |
NJ | 40QA00956500 | 2251X0800X, 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | |
No | 2251E1200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics |
No | 2251G0304X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics |
No | 2251H1300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Human Factors |
No | 2251N0400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology |
No | 2251P0200X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics |
No | 2251S0007X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports |
No | 2251X0800X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NJ | 105309DBD | Other | MEDICARE |