Healthcare Provider Details

I. General information

NPI: 1609820489
Provider Name (Legal Business Name): RESHMA MIRCHANDANI MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 FLANAGAN WAY
SECAUCUS NJ
07094-3433
US

IV. Provider business mailing address

38 CARR PL
FORDS NJ
08863-1006
US

V. Phone/Fax

Practice location:
  • Phone: 201-319-0010
  • Fax:
Mailing address:
  • Phone: 732-417-0213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01203600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: