MEDICARE: REKHA NAYAK P.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	225100000X	Physical Therapist	025346	NY
2	225100000X	Physical Therapist	40QA01289300	NJ

General Provider Information

NPI Number	:	1215164736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REKHA NAYAK P.T.

Provider Business Mailing Address
First Line	:	201 HOPKINS AVE
Second Line	:	# 1
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-3517
Country	:	US
Telephone Number	:	201-321-9790
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 RICHMOND AVE
Second Line	:	3RD FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1520
Country	:	US
Telephone Number	:	718-556-1616
Fax Number	:	718-442-9962

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

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	06/11/2009

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