Healthcare Provider Details

I. General information

NPI: 1235183062
Provider Name (Legal Business Name): PRASHANT M JUNANKAR MA, OTR, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LAKEVIEW AVE
CLIFTON NJ
07011-4041
US

IV. Provider business mailing address

61 LAKEVIEW AVE
CLIFTON NJ
07011-4041
US

V. Phone/Fax

Practice location:
  • Phone: 973-772-8006
  • Fax:
Mailing address:
  • Phone: 973-772-8006
  • Fax: 973-772-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number46TR001184
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: