NPIMap

Organization Active NPI

Nanda J Nevola PT PC

  • Physical Therapist
  • Valley Cottage, NY
National Provider Identifier
1790798890
Registry record updated Aug 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
015158 Issued in NY
Legal business name
NANDA J NEVOLA PT PC
Practice address
104 Lake Rd
Valley Cottage, NY 10989-2339
Phone
(845) 300-2847
Fax
(866) 841-2452
NPI assigned
Aug 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Nanda J Nevola, PT
Title
President
Phone
(453) 002-8478

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 015158 NY Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

104 Lake Rd
Valley Cottage, NY 10989-2339

Mailing address

104 Lake Rd
Valley Cottage, NY 10989-2339
Phone (845) 300-2847

Other identifiers 1

IdentifierTypeStateIssuer
NN0Q8W0H10OtherNYBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

54 N Broadway
Nyack, NY 10960
Phone (845) 348-8700

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567036800000",
    "number": "1790798890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 LAKE RD",
            "city": "VALLEY COTTAGE",
            "state": "NY",
            "postal_code": "109892339",
            "telephone_number": "845-300-2847",
            "fax_number": "866-841-2452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 LAKE RD",
            "city": "VALLEY COTTAGE",
            "state": "NY",
            "postal_code": "109892339",
            "telephone_number": "845-300-2847",
            "fax_number": "866-841-2452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NANDA J NEVOLA PT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2019-08-29",
        "status": "A",
        "authorized_official_last_name": "NEVOLA",
        "authorized_official_first_name": "NANDA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "453-002-8478",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "015158",
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "NN0Q8W0H10",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Valley Cottage, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.