Healthcare Provider Details

I. General information

NPI: 1871940874
Provider Name (Legal Business Name): MEGHAN MIZRACHI P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1556 3RD AVE STE 211
NEW YORK NY
10128-3100
US

IV. Provider business mailing address

525 WASHINGTON BLVD CLUB METRO
JERSEY CITY NJ
07310-1606
US

V. Phone/Fax

Practice location:
  • Phone: 212-353-8693
  • Fax: 347-507-5510
Mailing address:
  • Phone: 201-473-4654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01709300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number040132
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: