Provider Demographics
NPI:1376018291
Name:NAIR, PRIYA PRAKASH
Entity Type:Individual
Prefix:MRS
First Name:PRIYA
Middle Name:PRAKASH
Last Name:NAIR
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 1:65 BAY ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3011
Mailing Address - Country:US
Mailing Address - Phone:929-328-6595
Mailing Address - Fax:
Practice Address - Street 1:535 FLUSHING AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-1610
Practice Address - Country:US
Practice Address - Phone:718-488-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-07
Last Update Date:2018-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042921225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist