Provider Demographics
NPI:1083268569
Name:MARDIA, PRIYA SIDDHARTH
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:SIDDHARTH
Last Name:MARDIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MINNEHAHA BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-2722
Mailing Address - Country:US
Mailing Address - Phone:973-820-6621
Mailing Address - Fax:
Practice Address - Street 1:120 BENCHLEY PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3402
Practice Address - Country:US
Practice Address - Phone:347-843-7760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist