MEDICARE: PAWAN SHARMA L.M.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	024082	NY

General Provider Information

NPI Number	:	1043518210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAWAN SHARMA L.M.T.

Provider Business Mailing Address
First Line	:	1807 RANDALL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-3617
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 RANDALL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-3617
Country	:	US
Telephone Number	:	718-617-8349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2011
Last Update Date	:	03/11/2011

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