Provider Demographics
NPI:1063746774
Name:ZYLBERBERG, GUSTAVO (DPT)
Entity type:Individual
Prefix:MR
First Name:GUSTAVO
Middle Name:
Last Name:ZYLBERBERG
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 1:1455 49TH ST
Mailing Address - Street 2:APT 1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-3255
Mailing Address - Country:US
Mailing Address - Phone:917-279-9595
Mailing Address - Fax:
Practice Address - Street 1:1455 49TH ST
Practice Address - Street 2:APT 1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3255
Practice Address - Country:US
Practice Address - Phone:917-279-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist