MEDICARE: HARSHITHA MADHAVAN

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	055148	NY
2	225100000X	Physical Therapist	40QA02338800	NJ

General Provider Information

NPI Number	:	1720920887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARSHITHA MADHAVAN

Provider Business Mailing Address
First Line	:	30 INDEPENDENCE WAY
Second Line	:
City	:	ROCKAWAY
State	:	NJ
Zip	:	07866-4824
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 PASSAIC AVE
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-5811
Country	:	US
Telephone Number	:	973-758-9000
Fax Number	:

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

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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