Healthcare Provider Details

I. General information

NPI: 1477762722
Provider Name (Legal Business Name): SHILPA S. DEWOOLKAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 01/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 POLIFLY RD STE 104
HACKENSACK NJ
07601-1749
US

IV. Provider business mailing address

155 POLIFLY RD STE 104
HACKENSACK NJ
07601-1749
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-3644
  • Fax: 201-343-1770
Mailing address:
  • Phone: 201-343-3644
  • Fax: 201-343-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number46TR00069000
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number46TR00069000
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. SHILPA S DEWOOLKAR
Title or Position: SOLE PROPRIETOR
Credential: OTR,CHT
Phone: 201-343-3644