Provider Demographics
NPI:1174618904
Name:SOLOMIANKO, JAROSLAW ADAM (DPT)
Entity type:Individual
Prefix:MR
First Name:JAROSLAW
Middle Name:ADAM
Last Name:SOLOMIANKO
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 1:4 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3706
Mailing Address - Country:US
Mailing Address - Phone:516-931-2780
Mailing Address - Fax:516-938-1129
Practice Address - Street 1:4 PASADENA DR
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3706
Practice Address - Country:US
Practice Address - Phone:516-931-2780
Practice Address - Fax:516-938-1129
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN2781Medicare ID - Type UnspecifiedPROVIDER NUMBER