Provider Demographics
NPI:1285467936
Name:NADEEM, SAMRA
Entity type:Individual
Prefix:
First Name:SAMRA
Middle Name:
Last Name:NADEEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8746 20TH AVE # L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4802
Mailing Address - Country:US
Mailing Address - Phone:718-648-0888
Mailing Address - Fax:855-955-3899
Practice Address - Street 1:822 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4791
Practice Address - Country:US
Practice Address - Phone:718-648-0888
Practice Address - Fax:855-955-3899
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053077225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist