Provider Demographics
NPI:1437639911
Name:WADHWA, KARAN (PT)
Entity Type:Individual
Prefix:
First Name:KARAN
Middle Name:
Last Name:WADHWA
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 1:2010 FOXGLOVE CIR
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-3073
Mailing Address - Country:US
Mailing Address - Phone:716-262-5529
Mailing Address - Fax:
Practice Address - Street 1:68 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11977-1259
Practice Address - Country:US
Practice Address - Phone:631-240-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist