Provider Demographics
NPI:1750419347
Name:YUSUPOVA, ESTER (PT)
Entity type:Individual
Prefix:
First Name:ESTER
Middle Name:
Last Name:YUSUPOVA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 OCEAN PKWY
Mailing Address - Street 2:APT#4F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-5861
Mailing Address - Country:US
Mailing Address - Phone:347-529-3165
Mailing Address - Fax:347-529-3165
Practice Address - Street 1:540 OCEAN PKWY
Practice Address - Street 2:APT#4F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-5861
Practice Address - Country:US
Practice Address - Phone:347-529-3165
Practice Address - Fax:347-529-3165
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist