Provider Demographics
NPI:1285769588
Name:MAHAJAN, MADHURANI PRAKASH (PT, DPT)
Entity type:Individual
Prefix:
First Name:MADHURANI
Middle Name:PRAKASH
Last Name:MAHAJAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1785 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-2107
Mailing Address - Country:US
Mailing Address - Phone:646-820-5669
Mailing Address - Fax:646-368-8339
Practice Address - Street 1:1785 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2107
Practice Address - Country:US
Practice Address - Phone:646-820-5669
Practice Address - Fax:646-368-8339
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03232079Medicaid