Healthcare Provider Details

I. General information

NPI: 1215109871
Provider Name (Legal Business Name): NANDITA AGRAWAL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 FLANAGAN WAY
SECAUCUS NJ
07094-3445
US

IV. Provider business mailing address

150 FLANAGAN WAY
SECAUCUS NJ
07094-3445
US

V. Phone/Fax

Practice location:
  • Phone: 201-319-0010
  • Fax: 201-319-8994
Mailing address:
  • Phone: 201-319-0010
  • Fax: 201-319-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01274500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: