Provider Demographics
NPI:1760155246
Name:MAHARAJA, KERINA A (DPT)
Entity Type:Individual
Prefix:MS
First Name:KERINA
Middle Name:A
Last Name:MAHARAJA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W 14TH ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7527
Mailing Address - Country:US
Mailing Address - Phone:412-523-2970
Mailing Address - Fax:
Practice Address - Street 1:138 5TH AVE FL 2TH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4300
Practice Address - Country:US
Practice Address - Phone:212-287-4257
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046983-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist