MEDICARE: MRS. TANUJA TAJWATTIE BISNAUTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	005879-1	NY

General Provider Information

NPI Number	:	1811037039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TANUJA TAJWATTIE BISNAUTH

Provider Business Mailing Address
First Line	:	979 CROSS BRONX EXPY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-4885
Country	:	US
Telephone Number	:	718-665-7565
Fax Number	:	718-665-7595

Provider Business Practice Location Address
First Line	:	979 CROSS BRONX EXPY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10460-4885
Country	:	US
Telephone Number	:	718-665-7565
Fax Number	:	718-665-7595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	05/01/2019

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