Individual
DR. GHOLAMREZA JAHANARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DR PHYSICALTHERAPY
Contact information
Practice address
1822 CORPORAL KENNEDY ST, BAYSIDE, NY 11360-1447
(718) 224-5552
Mailing address
1822 CORPORAL KENNEDY ST, BAYSIDE, NY 11360-1447
(718) 224-5552
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
2251P0200X
Pediatric Physical Therapist
Primary
019910
NY
Other
Enumeration date
09/16/2008
Last updated
09/16/2008
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