Healthcare Provider Details

I. General information

NPI: 1134876394
Provider Name (Legal Business Name): NISHA KALIDAS SARGARAMARWADI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 FOREST AVE
STATEN ISLAND NY
10303-1506
US

IV. Provider business mailing address

299 PARSONAGE RD # 299
EDISON NJ
08837-2107
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-8205
  • Fax:
Mailing address:
  • Phone: 917-208-5903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048496
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: