Individual provider · NPI-1

Boris Avezov, D.P.T.

Specialist · Forest Hills, NY

NPI number1336690361
StatusActive
Last updated in NPPESMar 22, 2025

Details

NPI
1336690361
Entity type
Individual (NPI-1)
Name
Boris Avezov
Credential
D.P.T.
Sex
Male
Sole proprietor
No
Enumeration date
Oct 14, 2016
Certification date
Mar 22, 2025
Last updated
Mar 22, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
174400000X Specialist040332NYYes
225100000X Physical Therapist040332NY

Practice location

10236 64th Ave
Forest Hills, NY 11375-1547

Phone 347-599-6099

Mailing address

9614 Metropolitan Ave
Forest Hills, NY 11375-6674

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