Provider Demographics
NPI:1912023201
Name:POZHARSKY, KIM
Entity Type:Individual
Prefix:MR
First Name:KIM
Middle Name:
Last Name:POZHARSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 N MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-5597
Mailing Address - Country:US
Mailing Address - Phone:201-797-8830
Mailing Address - Fax:201-797-8862
Practice Address - Street 1:479 N MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5597
Practice Address - Country:US
Practice Address - Phone:201-797-8830
Practice Address - Fax:201-797-8862
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist