Provider Demographics
NPI:1952618928
Name:KUSHETSKY, JOANNA YAP
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:YAP
Last Name:KUSHETSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79TH SOUTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581
Mailing Address - Country:US
Mailing Address - Phone:212-481-8678
Mailing Address - Fax:212-481-6398
Practice Address - Street 1:303 5TH AVE
Practice Address - Street 2:SUITE 1413
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6601
Practice Address - Country:US
Practice Address - Phone:212-481-8678
Practice Address - Fax:212-481-6398
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28258225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist