Healthcare Provider Details

I. General information

NPI: 1750870135
Provider Name (Legal Business Name): SHREE HARIKRUSHAN PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2018
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 N MADISON AVE
SPRING VALLEY NY
10977-4811
US

IV. Provider business mailing address

60 N MADISON AVE
SPRING VALLEY NY
10977-4811
US

V. Phone/Fax

Practice location:
  • Phone: 845-414-9115
  • Fax:
Mailing address:
  • Phone: 845-414-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: CHANDRASHEKHAR ARDESANA
Title or Position: OWNER
Credential: PT
Phone: 973-722-7003