Provider Demographics
NPI:1447702576
Name:SURYAWANSHI, NEERAJA PUNIT
Entity type:Individual
Prefix:
First Name:NEERAJA
Middle Name:PUNIT
Last Name:SURYAWANSHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NEERAJA
Other - Middle Name:SUDHIR
Other - Last Name:WADODKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:509 MERRICK RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5436
Practice Address - Country:US
Practice Address - Phone:516-442-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037461225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist