Provider Demographics
NPI:1174048581
Name:KALLEY, BHAGYASHREE
Entity type:Individual
Prefix:
First Name:BHAGYASHREE
Middle Name:
Last Name:KALLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 GREENE ST APT 2308
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-7598
Mailing Address - Country:US
Mailing Address - Phone:716-440-0820
Mailing Address - Fax:
Practice Address - Street 1:227 W 29TH ST RM 3R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5574
Practice Address - Country:US
Practice Address - Phone:212-736-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0415892251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics