Provider Demographics
NPI:1295423275
Name:NAIK, NILASHRI MUKUND
Entity type:Individual
Prefix:
First Name:NILASHRI
Middle Name:MUKUND
Last Name:NAIK
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 1:42 FAIRFAX RD # NA
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-4135
Mailing Address - Country:US
Mailing Address - Phone:585-766-2782
Mailing Address - Fax:
Practice Address - Street 1:107 INSTITUTE ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6628
Practice Address - Country:US
Practice Address - Phone:716-484-4334
Practice Address - Fax:716-484-4335
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty