Proadvantage Physical Therapy Incorporated

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

40QA01242600 Issued in NJ

Legal business name

PROADVANTAGE PHYSICAL THERAPY INCORPORATED

Practice address

200 Winston Dr Apt 119
Cliffside Park, NJ 07010-3209

Phone

(617) 620-2137

NPI assigned

Aug 28, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yevgeny Fedosenko

Title

Owner

Phone

(617) 620-2137

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yev Fedosenko, D.P.T

  • Physical Therapist
  • Cliffside Park, NJ
  • NPI 1922290535
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773792000000",
    "number": "1003064452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 WINSTON DR APT 119",
            "city": "CLIFFSIDE PARK",
            "state": "NJ",
            "postal_code": "070103209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WINSTON DR APT 119",
            "city": "CLIFFSIDE PARK",
            "state": "NJ",
            "postal_code": "070103209",
            "telephone_number": "617-620-2137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROADVANTAGE PHYSICAL THERAPY INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-28",
        "last_updated": "2026-03-18",
        "certification_date": "2026-03-18",
        "status": "A",
        "authorized_official_last_name": "FEDOSENKO",
        "authorized_official_first_name": "YEVGENY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-620-2137"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NJ",
            "license": "40QA01242600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Cliffside Park, NJ
• Providers in Cliffside Park, NJ by specialty
• Physical Therapy Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.