Provider Demographics
NPI:1689029100
Name:SASIDHARAN, TAPAN (MPT)
Entity Type:Individual
Prefix:MR
First Name:TAPAN
Middle Name:
Last Name:SASIDHARAN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3303
Mailing Address - Country:US
Mailing Address - Phone:516-737-6505
Mailing Address - Fax:
Practice Address - Street 1:15 CEDAR LN
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3303
Practice Address - Country:US
Practice Address - Phone:516-737-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist