Individual ProviderNicholas VlassenkoPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address4280 Hylan Blvd, Staten Island, NY 10312-6526(718) 227-1832PECOS EnrollmentBased on the most recent information from CMS, provider Nicholas Vlassenko does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1871737163Provider TypeIndividualFull NameVlassenko, NicholasCredentialPTGenderMaleSole ProprietorYesEnumeration Date4/30/2009Last Updated4/30/2009Contact InformationPractice LocationPractice Address4280 Hylan Blvd, Staten Island, NY 10312-6526Phone(718) 227-1832Fax(718) 227-1089Mailing LocationMailing Address4280 Hylan Blvd, Staten Island, NY 10312Phone(718) 227-1832Fax(718) 227-1089Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense018529-1New York