Healthcare Provider Details

I. General information

NPI: 1972099695
Provider Name (Legal Business Name): BRANDON HULASIYA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 BROADWAY FL 15
NEW YORK NY
10023-5882
US

IV. Provider business mailing address

8 TUDOR CT
MATAWAN NJ
07747-3679
US

V. Phone/Fax

Practice location:
  • Phone: 212-712-2006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number043055
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: