Provider Demographics
NPI:1851455679
Name:VYAS, SEJAL H (PT)
Entity Type:Individual
Prefix:MS
First Name:SEJAL
Middle Name:H
Last Name:VYAS
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 1:40 WATERSIDE PLZ
Mailing Address - Street 2:#2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2631
Mailing Address - Country:US
Mailing Address - Phone:646-742-0165
Mailing Address - Fax:646-742-0462
Practice Address - Street 1:113 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4507
Practice Address - Country:US
Practice Address - Phone:646-742-0165
Practice Address - Fax:646-742-0462
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL2631Medicare ID - Type UnspecifiedPHYSICAL THERAPY