MEDICARE: DEEPA PAUL

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	046208	NY

General Provider Information

NPI Number	:	1669248332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPA PAUL

Provider Business Mailing Address
First Line	:	49 AMHERST DR, NY,10710
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10710
Country	:	US
Telephone Number	:	914-498-2821
Fax Number	:

Provider Business Practice Location Address
First Line	:	3867 E TREMONT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-2479
Country	:	US
Telephone Number	:	332-216-3179
Fax Number	:

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

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	12/04/2023

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Directions to “ DEEPA PAUL ” Practice Location

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