Healthcare Provider Details

I. General information

NPI: 1689031312
Provider Name (Legal Business Name): SHWETA DHUMAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 LETTS CT
EAST BRUNSWICK NJ
08816-5661
US

IV. Provider business mailing address

4 LETTS CT
EAST BRUNSWICK NJ
08816-5661
US

V. Phone/Fax

Practice location:
  • Phone: 908-528-1478
  • Fax:
Mailing address:
  • Phone: 908-528-1478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number039850-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01668300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number039850-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: