MEDICARE: ISHWA VIVEKKUMAR DAVE 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	051426	NY

General Provider Information

NPI Number	:	1770346728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISHWA VIVEKKUMAR DAVE PT

Provider Business Mailing Address
First Line	:	102 MADISON AVE FL 8
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-7584
Country	:	US
Telephone Number	:	212-759-2282
Fax Number	:	212-379-2123

Provider Business Practice Location Address
First Line	:	2273 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-5413
Country	:	US
Telephone Number	:	646-328-6040
Fax Number	:

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

Provider Enumeration Date	:	02/02/2024
Last Update Date	:	02/03/2026

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