MEDICARE: NEHA PATHAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	40QA01658600	NJ

General Provider Information

NPI Number	:	1134581424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEHA PATHAK

Provider Business Mailing Address
First Line	:	12 RENE CT
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-8415
Country	:	US
Telephone Number	:	909-554-0891
Fax Number	:

Provider Business Practice Location Address
First Line	:	881 ALLWOOD RD
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07012-1900
Country	:	US
Telephone Number	:	973-837-8300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	09/02/2022

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Directions to “ NEHA PATHAK ” Practice Location

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