=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942063094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAMUKH MEDICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2024
-----------------------------------------------------
Last Update Date | 11/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8008 ROUTE 130 STE A100
-----------------------------------------------------
City | DELRAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08075-1869
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-444-8405
-----------------------------------------------------
Fax | 856-444-8418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 WATERS EDGE DR
-----------------------------------------------------
City | DELRAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08075-1895
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-444-8405
-----------------------------------------------------
Fax | 856-444-8418
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | CHIRAG PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-266-2853
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------