Provider Demographics
NPI:1407886633
Name:PUSHNYA, NIKOLAI (PT)
Entity Type:Individual
Prefix:MR
First Name:NIKOLAI
Middle Name:
Last Name:PUSHNYA
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 1:340 EVELYN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2908
Mailing Address - Country:US
Mailing Address - Phone:201-265-5000
Mailing Address - Fax:201-265-5003
Practice Address - Street 1:340 EVELYN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2908
Practice Address - Country:US
Practice Address - Phone:201-265-5000
Practice Address - Fax:201-265-5003
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00873600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ041009Medicare UPIN