Basic Information
| Provider Information | |||||||||
| NPI: | 1508983545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHOLA | ||||||||
| FirstName: | EWA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| OtherLastName: | ZDUNCZYK | ||||||||
| OtherFirstName: | EWA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2142 UTOPIA PKWY | ||||||||
| Address2: | |||||||||
| City: | WHITESTONE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113574142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188196803 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1160 MONTAUK HWY | ||||||||
| Address2: | BOTTOM LEVEL | ||||||||
| City: | COPIAGUE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117264904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318424606 | ||||||||
| FaxNumber: | 6318420803 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2007 | ||||||||
| LastUpdateDate: | 06/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 028540 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.