Healthcare Provider Details

I. General information

NPI: 1164212494
Provider Name (Legal Business Name): NIDHI VALLABHBHAI JODHANI PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 AVENUE X
BROOKLYN NY
11223-5940
US

IV. Provider business mailing address

4901 BERGENLINE AVE APT 810
WEST NEW YORK NJ
07093-7306
US

V. Phone/Fax

Practice location:
  • Phone: 718-522-3399
  • Fax:
Mailing address:
  • Phone: 551-697-3343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054164
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: