Healthcare Provider Details

I. General information

NPI: 1700649068
Provider Name (Legal Business Name): MRS. PRIYANKA NISARG BHOJAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 E 84TH ST
NEW YORK NY
10028-2000
US

IV. Provider business mailing address

340 ORIENT WAY
LYNDHURST NJ
07071-1636
US

V. Phone/Fax

Practice location:
  • Phone: 212-327-0600
  • Fax: 212-327-0776
Mailing address:
  • Phone: 201-693-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number051786-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: