Healthcare Provider Details

I. General information

NPI: 1861082299
Provider Name (Legal Business Name): WINNIE MOKASHI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 NORTHERN BLVD STE 11
GREAT NECK NY
11021-4802
US

IV. Provider business mailing address

409 WILLIAM FLOYD PKWY
SHIRLEY NY
11967-3434
US

V. Phone/Fax

Practice location:
  • Phone: 516-829-0030
  • Fax:
Mailing address:
  • Phone: 631-552-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number046826-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: