NPIMap

Organization Active NPI

Avantgarde Rehabilitation Limited Liability Company

  • Physical Therapist
  • Staten Island, NY
National Provider Identifier
1881937423
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8002032 Issued in NY
Legal business name
AVANTGARDE REHABILITATION LIMITED LIABILITY COMPANY
Practice address
520 Bloomingdale Rd
Staten Island, NY 10309-2061
Phone
(718) 605-1300
Fax
(718) 605-8739
NPI assigned
Apr 2, 2013
Last updated
Jul 14, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

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

Authorized official

Name
Viktoriya Khomenko, DPTNPI 1104160464
Title
Owner
Phone
(718) 605-1300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 8002032 NY Primary

Addresses

Primary practice location

520 Bloomingdale Rd
Staten Island, NY 10309-2061

Mailing address

8 Bur CT
Manalapan, NJ 07726-1878
Phone (732) 995-9293

Other practice location 1

198 Route 9 Ste 100
Manalapan, NJ 07726
Phone (732) 617-9999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140324000644 NJ Part B Supplier - Clinic/Group Practice 0547491284 Receives reassigned benefits from 3 practitioners
Practice locations: Manalapan, NJ
O20180419000018 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0547491284 Receives reassigned benefits from 2 practitioners
Practice locations: Staten Island, NY

National Provider Directory

National Provider Directory

Locations

108 Woodward Rd
Manalapan, NJ 07726
Phone (201) 787-7142

520 Bloomingdale Rd
Staten Island, NY 10309
Phone (718) 605-1300

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1364860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752451200000",
    "number": "1881937423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 BUR CT",
            "city": "MANALAPAN",
            "state": "NJ",
            "postal_code": "077261878",
            "telephone_number": "732-995-9293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 BLOOMINGDALE RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103092061",
            "telephone_number": "718-605-1300",
            "fax_number": "718-605-8739"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "198 Route 9 Ste 100",
            "address_purpose": "LOCATION",
            "city": "Manalapan",
            "state": "NJ",
            "postal_code": "07726",
            "country_code": "US",
            "telephone_number": "732-617-9999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AVANTGARDE REHABILITATION LIMITED LIABILITY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-02",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A",
        "authorized_official_last_name": "KHOMENKO",
        "authorized_official_first_name": "VIKTORIYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-605-1300",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "8002032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; 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.