Provider Demographics
NPI:1902418023
Name:INDREKAR, TUSHAR (MS)
Entity Type:Individual
Prefix:
First Name:TUSHAR
Middle Name:
Last Name:INDREKAR
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9410 60TH AVE APT L1
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5041
Mailing Address - Country:US
Mailing Address - Phone:858-250-9759
Mailing Address - Fax:
Practice Address - Street 1:9410 60TH AVE APT L1
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5041
Practice Address - Country:US
Practice Address - Phone:858-250-9759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012539-01225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant