Healthcare Provider Details

I. General information

NPI: 1184011009
Provider Name (Legal Business Name): KANIKA KAKKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GRAND ST
NEW YORK NY
10002-4800
US

IV. Provider business mailing address

55 DINSMORE AVE APT # 302
FRAMINGHAM MA
01702-6012
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-1970
  • Fax: 212-420-1910
Mailing address:
  • Phone: 617-952-1486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number038358
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number038358
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: