MEDICARE: PRIYA SIDDHARTH MARDIA

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1083268569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIYA SIDDHARTH MARDIA

Provider Business Mailing Address
First Line	:	52 MINNEHAHA BLVD
Second Line	:
City	:	LAKE HIAWATHA
State	:	NJ
Zip	:	07034-2722
Country	:	US
Telephone Number	:	973-820-6621
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 BENCHLEY PL
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-3402
Country	:	US
Telephone Number	:	347-843-7760
Fax Number	:

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

Provider Enumeration Date	:	08/01/2019
Last Update Date	:	03/29/2021

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Directions to “ PRIYA SIDDHARTH MARDIA ” Practice Location

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