Healthcare Provider Details

I. General information

NPI: 1760668560
Provider Name (Legal Business Name): PRACHI SHAH BAKARANIA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 11/25/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 5TH AVE FL 5
NEW YORK NY
10036-4702
US

IV. Provider business mailing address

622 W 168TH ST PH 11-102
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-4878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number17696
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number032605
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: