Provider Demographics
NPI:1144353897
Name:PARKSPORTS PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:PARKSPORTS PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GILZON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-230-1180
Mailing Address - Street 1:142 PROSPECT PARK W APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4507
Mailing Address - Country:US
Mailing Address - Phone:718-230-1180
Mailing Address - Fax:718-230-1199
Practice Address - Street 1:670 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-230-1180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00145225100000X
NY011045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02447556Medicaid
NYA100025929Medicare PIN
NYA100025929Medicare PIN
NYA100025929Medicare PIN