Provider Demographics
NPI:1053354324
Name:NOYKHOVICH, EDUARD (DPT)
Entity type:Individual
Prefix:DR
First Name:EDUARD
Middle Name:
Last Name:NOYKHOVICH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4353
Mailing Address - Country:US
Mailing Address - Phone:347-262-3915
Mailing Address - Fax:718-676-5508
Practice Address - Street 1:2365 E 13TH ST
Practice Address - Street 2:2P
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4353
Practice Address - Country:US
Practice Address - Phone:347-262-3915
Practice Address - Fax:718-676-5508
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0255321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ07B21Medicare ID - Type Unspecified