Healthcare Provider Details

I. General information

NPI: 1497111470
Provider Name (Legal Business Name): PRANAV PHYSICAL THERAPY AND PILATES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PLAINFIELD AVE STE 6B
EDISON NJ
08817-6701
US

IV. Provider business mailing address

100 PLAINFIELD AVE STE 6B
EDISON NJ
08817-6701
US

V. Phone/Fax

Practice location:
  • Phone: 732-543-2828
  • Fax: 732-543-2827
Mailing address:
  • Phone: 732-543-2828
  • Fax: 732-543-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number40QA1037900
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: REENA SEHGAL
Title or Position: CEO
Credential: MPT
Phone: 732-690-7372