Provider Demographics
NPI:1972532273
Name:SIMKHAEVA, ANGELA (PT)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:SIMKHAEVA
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 1:3045 BRIGHTON 12TH ST
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5762
Mailing Address - Country:US
Mailing Address - Phone:718-332-3132
Mailing Address - Fax:718-332-3355
Practice Address - Street 1:3045 BRIGHTON 12TH ST
Practice Address - Street 2:SUITE 1G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5762
Practice Address - Country:US
Practice Address - Phone:718-332-3132
Practice Address - Fax:718-332-3355
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016693-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ3975OtherEMPIRE BLUECROSS BLUE SHI
NY01897709Medicaid
NY01897709Medicaid