Provider Demographics
NPI:1134847585
Name:KRASILOVSKY NY PT PLLC
Entity type:Organization
Organization Name:KRASILOVSKY NY PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASILOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-451-3643
Mailing Address - Street 1:991 US HIGHWAY 22 STE 200
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2957
Mailing Address - Country:US
Mailing Address - Phone:231-564-6389
Mailing Address - Fax:
Practice Address - Street 1:35 E 35TH ST RM 206A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3823
Practice Address - Country:US
Practice Address - Phone:231-564-6389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center