Healthcare Provider Details

I. General information

NPI: 1881059749
Provider Name (Legal Business Name): BIJAL GIRISHKUMAR BHADIYADRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2015
Last Update Date: 12/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GRAND ST 2ND FLOOR
NEW YORK NY
10002-4800
US

IV. Provider business mailing address

10151 CAMINO RUIZ APT 30
SAN DIEGO CA
92126-6402
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-1970
  • Fax:
Mailing address:
  • Phone: 916-425-3557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number037695
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: