Basic Information
| Provider Information | |||||||||
| NPI: | 1831134634 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SONEVYTSKY | ||||||||
| FirstName: | MARKIAN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1180 RARITAN RD | ||||||||
| Address2: | PO BOX 1014 | ||||||||
| City: | CLARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070661311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7328559751 | ||||||||
| FaxNumber: | 7328559755 | ||||||||
| Practice Location | |||||||||
| Address1: | 3276 WASHINGTON RD | ||||||||
| Address2: | |||||||||
| City: | PARLIN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088591676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322388484 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 01/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251E1200X | 0040QA00956500 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Ergonomics | 2251G0304X | 0040QA00956500 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Geriatrics | 2251H1300X | 0040QA00956500 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Human Factors | 2251N0400X | 0040QA00956500 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Neurology | 2251P0200X | 0040QA00956500 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Pediatrics | 2251S0007X | 0040QA00956500 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Sports | 2251X0800X | 40QA00956500 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic | 225100000X | 40QA00956500 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 105309DBD | 01 | NJ | MEDICARE | OTHER |