Provider Demographics
NPI:1861764789
Name:DESHPANDE, VARUN KUMAR (PT)
Entity type:Individual
Prefix:MR
First Name:VARUN
Middle Name:KUMAR
Last Name:DESHPANDE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:41-61 KISSENA BLVD.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3181
Mailing Address - Country:US
Mailing Address - Phone:718-463-6335
Mailing Address - Fax:
Practice Address - Street 1:4161 KISSENA BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3181
Practice Address - Country:US
Practice Address - Phone:718-463-6335
Practice Address - Fax:718-463-6087
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist