Provider Demographics
NPI:1962523209
Name:KURLAND, GERTINA TINA (PT)
Entity type:Individual
Prefix:MRS
First Name:GERTINA
Middle Name:TINA
Last Name:KURLAND
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 1:20814 RICHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3231
Mailing Address - Country:US
Mailing Address - Phone:718-776-6209
Mailing Address - Fax:718-358-3837
Practice Address - Street 1:4004 BOWNE ST
Practice Address - Street 2:1I
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6143
Practice Address - Country:US
Practice Address - Phone:718-539-3359
Practice Address - Fax:718-358-3837
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013300-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP05016Medicare UPIN
NY06792GMedicare ID - Type Unspecified