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General NPI Number Information
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NPI Number | 1073254611
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Entity Type | Individual
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Provider Name | PREMSHANKAR NADAR PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | WHITESTONE PHYSICAL THERAPY OF QUEENS, PC 150-12, LOWER LEVEL -1, 14TH AVE
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City | WHITESTONE
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State | NY
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Zip | 11357
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Country | US
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Telephone | 718-746-8757
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Fax |
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Provider Business Mailing Address
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Address Line | 30 PIKEVIEW TER
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City | SECAUCUS
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State | NJ
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Zip | 07094-3819
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Country | US
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Telephone | 201-912-7491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 045944
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License Number State |
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