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NPI Code Detail

MEDICARE: MANOJABASINGH RUSSALIAH

MEDICARE: MANOJABASINGH RUSSALIAH
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
1225100000XPhysical Therapist038995NY
22251X0800XOrthopedic Physical Therapist038995NY

General Provider Information

NPI Number : 1275070641
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANOJABASINGH RUSSALIAH
Provider Business Mailing Address
First Line : 4332 KISSENA BLVD
Second Line : 1T
City : FLUSHING
State : NY
Zip : 11355-2934
Country : US
Telephone Number : 518-364-2954
Fax Number :
Provider Business Practice Location Address
First Line : 8003 211TH ST
Second Line : HOLLIS HILLS
City : QUEENS VILLAGE
State : NY
Zip : 11427-1012
Country : US
Telephone Number : 518-364-2954
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2017
Last Update Date : 04/05/2017

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Directions to “ MANOJABASINGH RUSSALIAH ” Practice Location

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