Provider Demographics
NPI:1538682976
Name:MAJMUDAR, KOMAL VISHALKUMAR
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:VISHALKUMAR
Last Name:MAJMUDAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5009 SADLER GLEN PL
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6172
Mailing Address - Country:US
Mailing Address - Phone:804-496-0053
Mailing Address - Fax:
Practice Address - Street 1:13639 37TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4110
Practice Address - Country:US
Practice Address - Phone:718-886-8175
Practice Address - Fax:718-886-8177
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041687225100000X
VA2305212343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist