Healthcare Provider Details

I. General information

NPI: 1689117954
Provider Name (Legal Business Name): NAFISA FIDVI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13844 QUEENS BLVD
BRIARWOOD NY
11375
US

IV. Provider business mailing address

102-30, 67TH AVE, APT 7P
FOREST HILLS NY
11375
US

V. Phone/Fax

Practice location:
  • Phone: 718-523-9811
  • Fax:
Mailing address:
  • Phone: 315-272-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number037770-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: