Provider Demographics
NPI:1003113572
Name:NISHAR, SWARUPA AMIT (PT)
Entity Type:Individual
Prefix:
First Name:SWARUPA
Middle Name:AMIT
Last Name:NISHAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BOSTON TPKE
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2640
Mailing Address - Country:US
Mailing Address - Phone:508-853-4590
Mailing Address - Fax:949-756-4811
Practice Address - Street 1:280 BOSTON TPKE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2640
Practice Address - Country:US
Practice Address - Phone:508-853-4590
Practice Address - Fax:949-756-4811
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400045622Medicare PIN
NYA400045041Medicare PIN
NYA400044246Medicare PIN
NYA400044381Medicare PIN