Provider Demographics
NPI:1790157816
Name:DEWAN, RAJINDER (PT)
Entity Type:Individual
Prefix:
First Name:RAJINDER
Middle Name:
Last Name:DEWAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 FOREST AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2068
Mailing Address - Country:US
Mailing Address - Phone:516-759-2032
Mailing Address - Fax:516-759-2117
Practice Address - Street 1:189 FOREST AVE STE A
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2068
Practice Address - Country:US
Practice Address - Phone:516-759-2032
Practice Address - Fax:516-759-2117
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist