Basic Information
| Provider Information | |||||||||
| NPI: | 1134289796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IVASHENKO | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PT DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2147 ROUTE 27 | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327779733 | ||||||||
| FaxNumber: | 7327779730 | ||||||||
| Practice Location | |||||||||
| Address1: | 2147 ROUTE 27 | ||||||||
| Address2: | |||||||||
| City: | EDISON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7327779733 | ||||||||
| FaxNumber: | 7327779730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 04/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | 40QA00279700 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.