Healthcare Provider Details

I. General information

NPI: 1790463693
Provider Name (Legal Business Name): DHARTI PRAVIN KHOKHAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

3648 BROADWAY
NEW YORK NY
10031-2520
US

IV. Provider business mailing address

8 CLEVELAND AVE APT 1
HARRISON NJ
07029-1316
US

V. Phone/Fax

Practice location:
  • Phone: 212-281-4400
  • Fax: 212-928-7900
Mailing address:
  • Phone: 302-500-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number048531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: