Healthcare Provider Details

I. General information

NPI: 1477476604
Provider Name (Legal Business Name): DATTEY HARISHBHAI SUKHADIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 ROUTE 17 FL 1
RUTHERFORD NJ
07070-2575
US

IV. Provider business mailing address

301 ROUTE 17 FL 1
RUTHERFORD NJ
07070-2575
US

V. Phone/Fax

Practice location:
  • Phone: 201-460-0032
  • Fax:
Mailing address:
  • Phone: 201-460-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02427700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: