Provider Demographics
NPI:1063280683
Name:GOHAR, SERAFINA (PTA, CBIS)
Entity type:Individual
Prefix:
First Name:SERAFINA
Middle Name:
Last Name:GOHAR
Suffix:
Gender:F
Credentials:PTA, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FRAN LN
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2614
Mailing Address - Country:US
Mailing Address - Phone:631-891-5001
Mailing Address - Fax:
Practice Address - Street 1:78 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11977-1219
Practice Address - Country:US
Practice Address - Phone:631-288-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012002-01225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant