Active NPI
Aleksandr Goncharov, P.T.
- Physical Therapist
- Brooklyn, NY
National Provider Identifier
1467752865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 33232
- Practice address
- 1702 Avenue Z Apt 5B
Brooklyn, NY 11235-3657 - Phone
- (347) 784-4530
- Fax
- (347) 673-7904
- NPI assigned
- Nov 1, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 33232 | NY | Primary |
Addresses
Primary practice location
1702 Avenue Z Apt 5B
Brooklyn, NY 11235-3657
Mailing address
2530 Ocean Ave Apt 1D
Brooklyn, NY 11229-3928
Phone (347) 784-4530
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110207000973 | NY | Practitioner - Physical Therapist in Private Practice | 0143400267 | Practice locations: Brooklyn, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33232 | NY | MD | Addiction (Substance Use Disorder) Counselor |
| 033232 | NY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1288569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599696000000",
"number": "1467752865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2530 OCEAN AVE APT 1D",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112293928",
"telephone_number": "347-784-4530",
"fax_number": "347-673-7904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1702 AVENUE Z APT 5B",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112353657",
"telephone_number": "347-784-4530",
"fax_number": "347-673-7904"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GONCHAROV",
"first_name": "ALEKSANDR",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-11-01",
"last_updated": "2020-09-10",
"certification_date": "2020-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "33232",
"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 Sep 10, 2020; 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.