Provider Demographics
NPI:1437704855
Name:THAPA, SHIVAJI
Entity Type:Individual
Prefix:
First Name:SHIVAJI
Middle Name:
Last Name:THAPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 57TH ST STE 302
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3148
Mailing Address - Country:US
Mailing Address - Phone:212-265-2052
Mailing Address - Fax:212-265-2011
Practice Address - Street 1:315 W 57TH ST STE 302
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3148
Practice Address - Country:US
Practice Address - Phone:212-265-2052
Practice Address - Fax:212-265-2011
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty