=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649887514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THAKKER & AMIN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2020
-----------------------------------------------------
Last Update Date | 03/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 91 N YORK RD APT 400-09
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-266-3895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 91 N YORK RD APT 400-09
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-2155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-266-3895
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER, CEO
-----------------------------------------------------
Name | MR. ARJUN R THAKKER
-----------------------------------------------------
Credential | MPH, EPIDEMIOLOGY
-----------------------------------------------------
Telephone | 732-266-3895
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320600000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------