MEDICARE: URSHITA RAJUBHAI JIVANI I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	014796	NY

General Provider Information

NPI Number	:	1568393080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	URSHITA RAJUBHAI JIVANI I

Provider Business Mailing Address
First Line	:	31 RIDGE RD
Second Line	:
City	:	LYNDHURST
State	:	NJ
Zip	:	07071-1236
Country	:	US
Telephone Number	:	716-541-7790
Fax Number	:

Provider Business Practice Location Address
First Line	:	3052 BRIGHTON 1ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-8088
Country	:	US
Telephone Number	:	917-662-5776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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