Healthcare Provider Details

I. General information

NPI: 1801390695
Provider Name (Legal Business Name): PARSHWA RAJENDRA MEHTA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 E FORDHAM RD
BRONX NY
10458-5049
US

IV. Provider business mailing address

625 E FORDHAM RD
BRONX NY
10458-5049
US

V. Phone/Fax

Practice location:
  • Phone: 718-933-1900
  • Fax: 718-563-4039
Mailing address:
  • Phone: 718-933-1900
  • Fax: 718-563-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number040539
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: