Provider Demographics
NPI:1053554048
Name:KAUSHIK, GAURAV
Entity type:Individual
Prefix:
First Name:GAURAV
Middle Name:
Last Name:KAUSHIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PHILMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12565
Mailing Address - Country:US
Mailing Address - Phone:518-672-7408
Mailing Address - Fax:518-672-4721
Practice Address - Street 1:720 E ROMIE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4208
Practice Address - Country:US
Practice Address - Phone:831-424-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41470225100000X
NY031219225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist