Healthcare Provider Details

I. General information

NPI: 1801704705
Provider Name (Legal Business Name): PRACHI MULJI BHANUSHALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 BERGEN STREET, HARRISON
JERSEY CITY NJ
07029
US

IV. Provider business mailing address

288 SIP AVE
JERSEY CITY NJ
07306-6511
US

V. Phone/Fax

Practice location:
  • Phone: 973-561-0076
  • Fax:
Mailing address:
  • Phone: 201-275-8045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02436200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: