Provider Demographics
NPI:1750498630
Name:MAHARLIKA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MAHARLIKA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:CAJITA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-720-3790
Mailing Address - Street 1:38 LANGERE PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1850
Mailing Address - Country:US
Mailing Address - Phone:718-720-3790
Mailing Address - Fax:718-720-1238
Practice Address - Street 1:2751 27TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2451
Practice Address - Country:US
Practice Address - Phone:718-728-0612
Practice Address - Fax:718-545-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY343985Medicare UPIN