Provider Demographics
NPI:1396915286
Name:GHADIALI, NISHRIN MUSLIM
Entity type:Individual
Prefix:MRS
First Name:NISHRIN
Middle Name:MUSLIM
Last Name:GHADIALI
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 1:598 LIBERTY AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3911
Mailing Address - Country:US
Mailing Address - Phone:201-628-6070
Mailing Address - Fax:
Practice Address - Street 1:598 LIBERTY AVE
Practice Address - Street 2:APT 2
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3911
Practice Address - Country:US
Practice Address - Phone:201-628-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist