Healthcare Provider Details

I. General information

NPI: 1689316770
Provider Name (Legal Business Name): EM PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2022
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10615 QUEENS BLVD # B11
FOREST HILLS NY
11375-4301
US

IV. Provider business mailing address

10615 QUEENS BLVD # B11
FOREST HILLS NY
11375-4301
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-1161
  • Fax: 201-591-7839
Mailing address:
  • Phone: 646-389-1161
  • Fax: 201-591-7839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BHAVIK PRAFUL SHETH
Title or Position: PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 718-308-5225