Provider Demographics
NPI:1891064408
Name:THAKKAR, REEMA
Entity Type:Individual
Prefix:
First Name:REEMA
Middle Name:
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 YORK AVE
Mailing Address - Street 2:MAIN FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3443
Mailing Address - Country:US
Mailing Address - Phone:212-988-9057
Mailing Address - Fax:212-988-9196
Practice Address - Street 1:1400 YORK AVE
Practice Address - Street 2:MAIN FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3443
Practice Address - Country:US
Practice Address - Phone:212-988-9057
Practice Address - Fax:212-988-9196
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034639-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist