Provider Demographics
NPI:1205103876
Name:SKLOVSKIY, GEORGE (PT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SKLOVSKIY
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 1:1255 5TH AVE
Mailing Address - Street 2:SUITE 6 L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3852
Mailing Address - Country:US
Mailing Address - Phone:914-400-1500
Mailing Address - Fax:914-478-8781
Practice Address - Street 1:594 BROADWAY
Practice Address - Street 2:SUITE 1207
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-3233
Practice Address - Country:US
Practice Address - Phone:212-343-1500
Practice Address - Fax:212-343-1594
Is Sole Proprietor?:No
Enumeration Date:2011-11-25
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034416-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist