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Organization
NANDA J NEVOLA PT PC
Active
Organization
NANDA J NEVOLA PT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NANDA J NEVOLA PT (PRESIDENT)
(453) 002-8478
Entity
Organization
Contact information
Practice address
104 LAKE RD, VALLEY COTTAGE, NY 10989-2339
(845) 300-2847
(866) 841-2452
Mailing address
104 LAKE RD, VALLEY COTTAGE, NY 10989-2339
(845) 300-2847
(866) 841-2452
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
015158
NY
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NN0Q8W0H10
BLUE CROSS BLUE SHIELD
NY
Enumeration date
08/13/2006
Last updated
08/29/2019
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