Provider Demographics
NPI:1255367405
Name:KIBRIK, SVETLANA (PT)
Entity type:Individual
Prefix:MRS
First Name:SVETLANA
Middle Name:
Last Name:KIBRIK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 WEST 1ST STREET
Mailing Address - Street 2:APT F1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:917-769-9986
Mailing Address - Fax:347-254-6083
Practice Address - Street 1:1543 WEST 1ST STREET
Practice Address - Street 2:APT F1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:917-769-9986
Practice Address - Fax:347-254-6083
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021229225100000X
NJQA0116300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02284655Medicaid
NJ083469Medicare ID - Type Unspecified
NYQE0531Medicare ID - Type Unspecified