Provider Demographics
NPI:1023063302
Name:CYRELSON, SASHA (DPT)
Entity type:Individual
Prefix:
First Name:SASHA
Middle Name:
Last Name:CYRELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TUCKERTON RD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-8806
Mailing Address - Country:US
Mailing Address - Phone:856-396-2250
Mailing Address - Fax:856-810-0373
Practice Address - Street 1:524 WILLIAMSTOWN RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1800
Practice Address - Country:US
Practice Address - Phone:856-516-0591
Practice Address - Fax:856-516-0592
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018197225100000X
NJ40QA01012600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS88981Medicare UPIN
NYBB7231Medicare PIN
NYQ45841Medicare PIN
NY650023538Medicare PIN