Healthcare Provider Details

I. General information

NPI: 1932335684
Provider Name (Legal Business Name): NEELU MISHRA PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NEELU SHARMA

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E 113TH ST
NEW YORK NY
10029-2207
US

IV. Provider business mailing address

144 E ALLENDALE RD
SADDLE RIVER NJ
07458-2719
US

V. Phone/Fax

Practice location:
  • Phone: 212-876-1829
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number026970
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026970
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: