Provider Demographics
NPI:1457888265
Name:MAJMUNDAR, MRUNALINI KANCHANLAL (PTA)
Entity Type:Individual
Prefix:
First Name:MRUNALINI
Middle Name:KANCHANLAL
Last Name:MAJMUNDAR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 KISSENA BLVD
Mailing Address - Street 2:APT 12A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3769
Mailing Address - Country:US
Mailing Address - Phone:347-476-1924
Mailing Address - Fax:718-878-2068
Practice Address - Street 1:4370 KISSENA BLVD
Practice Address - Street 2:APT 12A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3769
Practice Address - Country:US
Practice Address - Phone:347-476-1924
Practice Address - Fax:718-878-2068
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004635-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant