Provider Demographics
NPI:1881242790
Name:MUSDHAN GURUMOHAMED, RAJA MOHAMED (PT)
Entity type:Individual
Prefix:
First Name:RAJA MOHAMED
Middle Name:
Last Name:MUSDHAN GURUMOHAMED
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2506
Mailing Address - Country:US
Mailing Address - Phone:716-603-6234
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER
Practice Address - Street 2:647 BRYANT AVE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474
Practice Address - Country:US
Practice Address - Phone:347-899-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039409225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist