Provider Demographics
NPI:1922114024
Name:JADOONANAN, NEISHA A (PT)
Entity Type:Individual
Prefix:
First Name:NEISHA
Middle Name:A
Last Name:JADOONANAN
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:PO BOX 528160
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11352-8160
Mailing Address - Country:US
Mailing Address - Phone:718-878-2224
Mailing Address - Fax:718-878-2010
Practice Address - Street 1:4344 KISSENA BLVD
Practice Address - Street 2:STE LA
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3766
Practice Address - Country:US
Practice Address - Phone:718-878-2224
Practice Address - Fax:718-878-2010
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016667-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01932356Medicaid
NYQ35590Medicare UPIN