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NPI Code Detail

MEDICARE: SHOBA KOSHY MAMMEN PT

MEDICARE: SHOBA KOSHY MAMMEN PT
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
1225100000XPhysical Therapist020290-1NY

General Provider Information

NPI Number : 1831119775
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHOBA KOSHY MAMMEN PT
Provider Business Mailing Address
First Line : 300 S PASCACK RD
Second Line :
City : NANUET
State : NY
Zip : 10954-6514
Country : US
Telephone Number : 845-627-3505
Fax Number :
Provider Business Practice Location Address
First Line : 99 DUTCH HILL RD
Second Line :
City : ORANGEBURG
State : NY
Zip : 10962-2106
Country : US
Telephone Number : 845-398-2800
Fax Number : 845-398-2818
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 05/30/2008

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Directions to “ SHOBA KOSHY MAMMEN PT” Practice Location

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