Provider Demographics
NPI:1043484694
Name:NAGAPPAN, SURESH B (PT)
Entity Type:Individual
Prefix:MR
First Name:SURESH
Middle Name:B
Last Name:NAGAPPAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10992-1268
Mailing Address - Country:US
Mailing Address - Phone:845-569-1277
Mailing Address - Fax:845-496-3287
Practice Address - Street 1:815 BLOOMING GROVE TPKE
Practice Address - Street 2:FORGE HILL VILLAGE # 801
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-8135
Practice Address - Country:US
Practice Address - Phone:845-569-1277
Practice Address - Fax:845-496-3287
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019638-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ05441Medicare PIN