Provider Demographics
NPI:1922326537
Name:JIWANI, NIHA GULAMALI (PT)
Entity Type:Individual
Prefix:
First Name:NIHA
Middle Name:GULAMALI
Last Name:JIWANI
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 1:174 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4803
Mailing Address - Country:US
Mailing Address - Phone:914-328-8077
Mailing Address - Fax:914-328-6083
Practice Address - Street 1:6517 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-6248
Practice Address - Country:US
Practice Address - Phone:718-497-1150
Practice Address - Fax:718-417-0912
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032187225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400030675Medicare PIN
NYA400069692Medicare PIN
NYA400030579Medicare PIN
NYA400030315Medicare PIN
NYG400021955Medicare PIN
NYA400030206Medicare PIN
NYA400030246Medicare PIN