MEDICARE: PUJA SAWHNEY-BASRA 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	021897-1	NY

General Provider Information

NPI Number	:	1598064198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PUJA SAWHNEY-BASRA PT

Provider Business Mailing Address
First Line	:	569 E MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8505
Country	:	US
Telephone Number	:	631-665-8645
Fax Number	:

Provider Business Practice Location Address
First Line	:	569 E MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8505
Country	:	US
Telephone Number	:	631-462-0118
Fax Number	:

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

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	03/22/2011

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