Individual provider Active NPI

Boris Khotylev, P.T.

  • Geriatric Physical Therapist
  • Brooklyn, NY
National Provider Identifier
1396943577
Registry record updated Aug 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Physical TherapistTaxonomy code 2251G0304X
Practice address
2126 Benson Ave Apt 5H
Brooklyn, NY 11214-5033
Phone
(347) 673-6817
NPI assigned
Jul 10, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Physical Therapist 2251G0304X Primary

Addresses

Primary practice location

2126 Benson Ave Apt 5H
Brooklyn, NY 11214-5033

Mailing address

1806 Voorhies Ave, Apt 3B
Brooklyn, NY 11235-3648
Phone (718) 427-0362

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
027268NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Advance Plus Physical Therapy Services PC Past Accepting new patients
Prosolution Rehab Services OT PT PLLC PastSince Oct 1, 2012 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438732800000",
    "number": "1396943577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1806 VOORHIES AVE, APT 3B",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112353648",
            "telephone_number": "718-427-0362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2126 BENSON AVE APT 5H",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112145033",
            "telephone_number": "347-673-6817"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOTYLEV",
        "first_name": "BORIS",
        "credential": "P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2015-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.