Provider Demographics
NPI:1205073897
Name:DVOSKIN, VITALY (DPT)
Entity type:Individual
Prefix:DR
First Name:VITALY
Middle Name:
Last Name:DVOSKIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 60TH ST
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1107
Mailing Address - Country:US
Mailing Address - Phone:917-604-8612
Mailing Address - Fax:917-604-8612
Practice Address - Street 1:605 MADISON AVE
Practice Address - Street 2:4TH FLOOR/JFGYMNASTIQUE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1900
Practice Address - Country:US
Practice Address - Phone:888-705-2227
Practice Address - Fax:888-705-2297
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030873225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist