Provider Demographics
NPI:1154522258
Name:SIVARAMAN, VENKATESAN (PT)
Entity type:Individual
Prefix:
First Name:VENKATESAN
Middle Name:
Last Name:SIVARAMAN
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248-22 JERICHO TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE TERRACE
Mailing Address - State:NY
Mailing Address - Zip Code:11001-4002
Mailing Address - Country:US
Mailing Address - Phone:516-850-1285
Mailing Address - Fax:855-635-6565
Practice Address - Street 1:248-22 JERICHO TURNPIKE
Practice Address - Street 2:
Practice Address - City:BELLEROSE TERRACE
Practice Address - State:NY
Practice Address - Zip Code:11001-4002
Practice Address - Country:US
Practice Address - Phone:516-850-1285
Practice Address - Fax:855-635-6565
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0170691174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist