MEDICARE: NEHAL TUSHARBHAI CHANDRAMAULI

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	034940	NY

General Provider Information

NPI Number	:	1336407428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEHAL TUSHARBHAI CHANDRAMAULI

Provider Business Mailing Address
First Line	:	2964 BRIGHTON 6TH ST
Second Line	:	UNIT M2
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8532
Country	:	US
Telephone Number	:	718-758-4520
Fax Number	:

Provider Business Practice Location Address
First Line	:	2964 BRIGHTON 6TH ST
Second Line	:	UNIT M2
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8532
Country	:	US
Telephone Number	:	718-758-4520
Fax Number	:

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

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	04/26/2012

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