MEDICARE: SHASHI TANK

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	225200000X	Physical Therapy Assistant	40QB00302300	NJ
2	225100000X	Physical Therapist	40QA01946400	NJ

General Provider Information

NPI Number	:	1962896407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHASHI TANK

Provider Business Mailing Address
First Line	:	103 PLEASANT VALLEY WAY
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2905
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 PLEASANT VALLEY WAY
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-2905
Country	:	US
Telephone Number	:	973-731-2300
Fax Number	:

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

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	11/30/2020

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Directions to “ SHASHI TANK ” Practice Location

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