Basic Information
| Provider Information | |||||||||
| NPI: | 1093338303 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLUSHAKOV | ||||||||
| FirstName: | PAUL | ||||||||
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| Credential: | PT, DPT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 E 32ND ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100165595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127592282 | ||||||||
| FaxNumber: | 2123792123 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 TOMPKINS AVE | ||||||||
| Address2: | |||||||||
| City: | PLEASANTVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105703146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9143582900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2020 | ||||||||
| LastUpdateDate: | 04/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 042518-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.