Provider Demographics
NPI:1558079467
Name:PONNAIAHNADAR, SUDHAN PAULTHURAI (PT)
Entity Type:Individual
Prefix:
First Name:SUDHAN
Middle Name:PAULTHURAI
Last Name:PONNAIAHNADAR
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 1:2249
Mailing Address - Street 2:GLENWOOD RD
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:201-918-1239
Mailing Address - Fax:
Practice Address - Street 1:2249
Practice Address - Street 2:GLENWOOD RD
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850
Practice Address - Country:US
Practice Address - Phone:201-918-1239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist