Provider Demographics
NPI:1013291202
Name:KADAM, MAITHILEE SANJEEV (MS)
Entity Type:Individual
Prefix:
First Name:MAITHILEE SANJEEV
Middle Name:
Last Name:KADAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RIVER DR S
Mailing Address - Street 2:APT 512, THE PACIFIC
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-5700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:61 BROADWAY
Practice Address - Street 2:SUITE 2824
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2701
Practice Address - Country:US
Practice Address - Phone:212-981-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033664225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist