Provider Demographics
NPI:1538444849
Name:VELEDNITSKIY, ALEX (PT,DPT,CSCS)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:VELEDNITSKIY
Suffix:
Gender:M
Credentials:PT,DPT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 PERSHING RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3460
Mailing Address - Country:US
Mailing Address - Phone:718-915-5294
Mailing Address - Fax:
Practice Address - Street 1:449 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-5105
Practice Address - Country:US
Practice Address - Phone:201-455-7858
Practice Address - Fax:201-243-9898
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031921225100000X
NJ40QA01461600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist