Provider Demographics
NPI:1073254611
Name:NADAR, PREMSHANKAR (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:PREMSHANKAR
Middle Name:
Last Name:NADAR
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PIKEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3819
Mailing Address - Country:US
Mailing Address - Phone:201-912-7491
Mailing Address - Fax:
Practice Address - Street 1:WHITESTONE PHYSICAL THERAPY OF QUEENS, PC
Practice Address - Street 2:150-12, LOWER LEVEL -1, 14TH AVE
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357
Practice Address - Country:US
Practice Address - Phone:718-746-8757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
045944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist