Provider Demographics
NPI:1104463934
Name:MESHERIAKOV, IRINA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:MESHERIAKOV
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 EDGEGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2407
Mailing Address - Country:US
Mailing Address - Phone:917-660-3776
Mailing Address - Fax:
Practice Address - Street 1:848 EDGEGROVE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2407
Practice Address - Country:US
Practice Address - Phone:917-660-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist