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NPI Code Detail

MEDICARE: DR. ASHISH BASAVARAJ P.T., D.P.T.

MEDICARE:  DR. ASHISH  BASAVARAJ  P.T., D.P.T.
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
1225100000XPhysical Therapist023750-1NY

General Provider Information

NPI Number : 1740322023
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ASHISH BASAVARAJ P.T., D.P.T.
Provider Business Mailing Address
First Line : 21930 75TH AVE
Second Line : 1ST FLOOR
City : OAKLAND GARDENS
State : NY
Zip : 11364-3044
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20809 UNION TPKE
Second Line :
City : OAKLAND GARDENS
State : NY
Zip : 11364-3235
Country : US
Telephone Number : 718-479-6370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2007
Last Update Date : 09/10/2009

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