Healthcare Provider Details

I. General information

NPI: 1962180851
Provider Name (Legal Business Name): JANHVI REVANAND ANDHALE PTA,MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 HENRY HUDSON PKWY STE 103
BRONX NY
10463-4701
US

IV. Provider business mailing address

50 NEPPERHAN ST
YONKERS NY
10701-3800
US

V. Phone/Fax

Practice location:
  • Phone: 718-884-0444
  • Fax: 718-549-0415
Mailing address:
  • Phone: 217-200-1666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number014464
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: