MEDICARE: SWARALI SANJIV RUPJI

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	:	1366224107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SWARALI SANJIV RUPJI

Provider Business Mailing Address
First Line	:	3704 91ST ST STE B
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7909
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	37-04 91 ST. STREET
Second Line	:	JACKSON HEIGHTS
City	:	NEW YORK
State	:	NY
Zip	:	11372
Country	:	US
Telephone Number	:	929-401-4935
Fax Number	:

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

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	10/17/2023

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