Provider Demographics
NPI:1659388023
Name:IYER, KALPANA K (PT)
Entity Type:Individual
Prefix:MS
First Name:KALPANA
Middle Name:K
Last Name:IYER
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:PO BOX 120075
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-0075
Mailing Address - Country:US
Mailing Address - Phone:718-605-0055
Mailing Address - Fax:
Practice Address - Street 1:5428 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3943
Practice Address - Country:US
Practice Address - Phone:718-605-0055
Practice Address - Fax:718-605-0066
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012060-1225100000X
NJ40QA00667200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ39931Medicare ID - Type Unspecified
NJ696463Medicare ID - Type Unspecified