Provider Demographics
NPI:1629389259
Name:MEMON, NADIR (DPT)
Entity Type:Individual
Prefix:
First Name:NADIR
Middle Name:
Last Name:MEMON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 LARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2905
Mailing Address - Country:US
Mailing Address - Phone:631-623-6371
Mailing Address - Fax:631-623-6373
Practice Address - Street 1:346 LARKFIELD RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2905
Practice Address - Country:US
Practice Address - Phone:631-623-6371
Practice Address - Fax:631-623-6373
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032749-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist