Provider Demographics
NPI:1609337815
Name:MAHARJAN, PRATISTHA
Entity Type:Individual
Prefix:
First Name:PRATISTHA
Middle Name:
Last Name:MAHARJAN
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 1:42ND STREET
Mailing Address - Street 2:3226
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103
Mailing Address - Country:US
Mailing Address - Phone:916-884-1546
Mailing Address - Fax:
Practice Address - Street 1:86TH STREET
Practice Address - Street 2:2W #1
Practice Address - City:MANHATTAN
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:916-884-1546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist