MEDICARE: JEDHEESH PERUVINGAL PT

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	018928	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578752234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEDHEESH PERUVINGAL PT

Provider Business Mailing Address
First Line	:	46 BELLWOOD DR
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-3748
Country	:	US
Telephone Number	:	516-360-7502
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 HILLSIDE AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-2603
Country	:	US
Telephone Number	:	516-616-0942
Fax Number	:

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	02/04/2025

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