Provider Demographics
NPI:1134155492
Name:PALTIELOV, BORIS I (PT)
Entity type:Individual
Prefix:MR
First Name:BORIS
Middle Name:I
Last Name:PALTIELOV
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11027 70TH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3933
Mailing Address - Country:US
Mailing Address - Phone:718-606-1911
Mailing Address - Fax:718-709-4166
Practice Address - Street 1:6405 YELLOWSTONE BLVD APT 101
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1534
Practice Address - Country:US
Practice Address - Phone:718-606-1911
Practice Address - Fax:718-709-4166
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400001326OtherPTAN
NY05109Medicare PIN