Provider Demographics
NPI:1245679877
Name:RAO, NAMITA
Entity type:Individual
Prefix:
First Name:NAMITA
Middle Name:
Last Name:RAO
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 1:8003 211TH ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1012
Mailing Address - Country:US
Mailing Address - Phone:646-998-8128
Mailing Address - Fax:
Practice Address - Street 1:8003 211TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11427-1012
Practice Address - Country:US
Practice Address - Phone:646-998-8128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 0363582251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY45-3746636Medicaid
NY45-3746636Medicare UPIN
NY45-3746636Medicare PIN