Provider Demographics
NPI:1447598628
Name:MAHAJAN, NIDHI (PT)
Entity Type:Individual
Prefix:
First Name:NIDHI
Middle Name:
Last Name:MAHAJAN
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 1:28-18 31ST STREET
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1760
Mailing Address - Country:US
Mailing Address - Phone:718-956-6565
Mailing Address - Fax:718-956-5890
Practice Address - Street 1:28-18 31ST STREET
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1760
Practice Address - Country:US
Practice Address - Phone:718-956-6565
Practice Address - Fax:718-956-5890
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist