MEDICARE: MRS. NISHRIN MUSLIM GHADIALI

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	030026	NY

General Provider Information

NPI Number	:	1396915286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NISHRIN MUSLIM GHADIALI

Provider Business Mailing Address
First Line	:	598 LIBERTY AVE
Second Line	:	APT 2
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-3911
Country	:	US
Telephone Number	:	201-628-6070
Fax Number	:

Provider Business Practice Location Address
First Line	:	598 LIBERTY AVE
Second Line	:	APT 2
City	:	JERSEY CITY
State	:	NJ
Zip	:	07307-3911
Country	:	US
Telephone Number	:	201-628-6070
Fax Number	:

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

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	05/19/2009

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