Provider Demographics
NPI:1124080023
Name:SONI, NILESH (MSPT, MAPT)
Entity type:Individual
Prefix:MR
First Name:NILESH
Middle Name:
Last Name:SONI
Suffix:
Gender:M
Credentials:MSPT, MAPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 KISSENA BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2950
Mailing Address - Country:US
Mailing Address - Phone:917-207-2950
Mailing Address - Fax:516-746-1039
Practice Address - Street 1:4343 KISSENA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2950
Practice Address - Country:US
Practice Address - Phone:917-207-2950
Practice Address - Fax:516-746-1039
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY PT LIC NO: 014635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06078GMedicare PIN