Provider Demographics
NPI:1558490623
Name:JAVIDAN, NASRIN (PT)
Entity Type:Individual
Prefix:
First Name:NASRIN
Middle Name:
Last Name:JAVIDAN
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 1:18 ASHFORD AVE
Mailing Address - Street 2:STE 3E
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-1823
Mailing Address - Country:US
Mailing Address - Phone:914-693-5459
Mailing Address - Fax:914-693-4497
Practice Address - Street 1:18 ASHFORD AVE
Practice Address - Street 2:STE 3E
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1823
Practice Address - Country:US
Practice Address - Phone:914-693-5459
Practice Address - Fax:914-693-4497
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0146441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ45451Medicare PIN