MEDICARE: MISS ASMITA M ASEGAONKAR MSOTRL

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	225X00000X	Occupational Therapist	46TR00519300	NJ

General Provider Information

NPI Number	:	1255853743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ASMITA M ASEGAONKAR MSOTRL

Provider Business Mailing Address
First Line	:	361 MONTGOMERY ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3345
Country	:	US
Telephone Number	:	201-932-2656
Fax Number	:	201-603-2454

Provider Business Practice Location Address
First Line	:	361 MONTGOMERY ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3345
Country	:	US
Telephone Number	:	201-932-2656
Fax Number	:	201-603-2454

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

Provider Enumeration Date	:	07/17/2017
Last Update Date	:	07/17/2017

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