Provider Demographics
NPI:1326506494
Name:PHYSIATRY CONNECT PLLC
Entity Type:Organization
Organization Name:PHYSIATRY CONNECT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJA-RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-422-9113
Mailing Address - Street 1:1211 MARCONI ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4209
Mailing Address - Country:US
Mailing Address - Phone:646-422-9113
Mailing Address - Fax:
Practice Address - Street 1:1211 MARCONI ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4209
Practice Address - Country:US
Practice Address - Phone:646-422-9113
Practice Address - Fax:818-671-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR9534OtherTEXAS MEDICAL LICENSE