=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487536058
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STUTI RAVINDRABHAI PANCHOLI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2025
-----------------------------------------------------
Last Update Date | 07/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7 W 45TH ST FL 9
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10036-4905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-665-7109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 COLUMBIA AVE
-----------------------------------------------------
City | JERSEY CITY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07307-4131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 848-336-7034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 054257
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------