Provider Demographics
NPI:1386213585
Name:MAKADIA, BRINDA (PT)
Entity Type:Individual
Prefix:
First Name:BRINDA
Middle Name:
Last Name:MAKADIA
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 1:2854 JOHN F KENNEDY BLVD APT 1214
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4020
Mailing Address - Country:US
Mailing Address - Phone:551-358-4928
Mailing Address - Fax:
Practice Address - Street 1:1720 E 14TH ST STE M1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2088
Practice Address - Country:US
Practice Address - Phone:347-338-0036
Practice Address - Fax:718-375-0063
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046179-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist