Provider Demographics
NPI:1982267654
Name:BROOKLYN PHYSICAL AND OCCUPATIONAL THERAPY, PLLC
Entity Type:Organization
Organization Name:BROOKLYN PHYSICAL AND OCCUPATIONAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GILZON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-833-1273
Mailing Address - Street 1:391 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5607
Mailing Address - Country:US
Mailing Address - Phone:917-833-1273
Mailing Address - Fax:718-230-1199
Practice Address - Street 1:142 PROSPECT PARK W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4506
Practice Address - Country:US
Practice Address - Phone:917-833-1273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARKSPORTS PHYSICAL THERAPY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty