Provider Demographics
NPI:1235883083
Name:FOCARILE, NISHAAT (PT)
Entity Type:Individual
Prefix:
First Name:NISHAAT
Middle Name:
Last Name:FOCARILE
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 1:3 SUNFLOWER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3700
Mailing Address - Country:US
Mailing Address - Phone:516-384-6666
Mailing Address - Fax:
Practice Address - Street 1:3 SUNFLOWER RIDGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-3700
Practice Address - Country:US
Practice Address - Phone:516-384-6666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist