Provider Demographics
NPI:1245581651
Name:GHOSH, SIDDHARTH (PT)
Entity Type:Individual
Prefix:
First Name:SIDDHARTH
Middle Name:
Last Name:GHOSH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 N BROADWAY
Mailing Address - Street 2:SUITE L-09
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1318
Mailing Address - Country:US
Mailing Address - Phone:914-476-8600
Mailing Address - Fax:914-476-0240
Practice Address - Street 1:984 N BROADWAY
Practice Address - Street 2:SUITE L-09
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1318
Practice Address - Country:US
Practice Address - Phone:914-476-8600
Practice Address - Fax:914-476-0240
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist