Provider Demographics
NPI:1871796169
Name:NAIR, RUPA RAVINDRANATHAN (PT)
Entity type:Individual
Prefix:
First Name:RUPA
Middle Name:RAVINDRANATHAN
Last Name:NAIR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 HENLEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-2043
Mailing Address - Country:US
Mailing Address - Phone:501-733-5685
Mailing Address - Fax:
Practice Address - Street 1:313 HENLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-2043
Practice Address - Country:US
Practice Address - Phone:501-733-5685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQN12139041Medicare PIN
NYA400035323Medicare PIN
NYA400069914Medicare PIN
NYA400034537Medicare PIN
NYA400036012Medicare PIN