Healthcare Provider Details

I. General information

NPI: 1992622179
Provider Name (Legal Business Name): NAVANITA PURKAYASTHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RIVER RD APT C5
EDGEWATER NJ
07020-1373
US

IV. Provider business mailing address

1111 RIVER RD APT C5
EDGEWATER NJ
07020-1373
US

V. Phone/Fax

Practice location:
  • Phone: 718-704-7062
  • Fax:
Mailing address:
  • Phone: 718-704-7062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number034722
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT021937
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24821
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012666
License Number StateCT
# 5
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02410700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: