MEDICARE: NIYATI TEMBE

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	037499-1	NY

General Provider Information

NPI Number	:	1215356829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIYATI TEMBE

Provider Business Mailing Address
First Line	:	2303 DEERFIELD DR
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08820-1582
Country	:	US
Telephone Number	:	516-366-9014
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2560
Country	:	US
Telephone Number	:	718-502-5271
Fax Number	:

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

Provider Enumeration Date	:	04/10/2014
Last Update Date	:	03/24/2016

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