Provider Demographics
NPI:1588899629
Name:MAMAYEV, RUSLANA (DPT)
Entity type:Individual
Prefix:
First Name:RUSLANA
Middle Name:
Last Name:MAMAYEV
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2964 BRIGHTON 12TH ST
Mailing Address - Street 2:F2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4750
Mailing Address - Country:US
Mailing Address - Phone:646-662-2264
Mailing Address - Fax:
Practice Address - Street 1:2075 E 68TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6009
Practice Address - Country:US
Practice Address - Phone:718-968-7866
Practice Address - Fax:718-968-7918
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0255572251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics