Healthcare Provider Details

I. General information

NPI: 1003627621
Provider Name (Legal Business Name): TANMAY R KHESE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MAIDEN LN
NEW YORK NY
10038-4811
US

IV. Provider business mailing address

1204 W ADAMS BLVD APT 6
LOS ANGELES CA
90007-1703
US

V. Phone/Fax

Practice location:
  • Phone: 888-806-2497
  • Fax:
Mailing address:
  • Phone: 213-691-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: