=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235183062
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRASHANT M JUNANKAR MA, OTR, PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 08/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 61 LAKEVIEW AVE
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07011-4041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-772-8006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 61 LAKEVIEW AVE
-----------------------------------------------------
City | CLIFTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07011-4041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-772-8006
-----------------------------------------------------
Fax | 973-772-0907
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XH1200X
-----------------------------------------------------
Taxonomy Name | Hand Occupational Therapist
-----------------------------------------------------
License Number | 46TR001184
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------