Basic Information
| Provider Information | |||||||||
| NPI: | 1912543984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHINDE | ||||||||
| FirstName: | PRITI PRAVIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 HARMON COVE TOWER | ||||||||
| Address2: | |||||||||
| City: | SECAUCUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070941729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9179357155 | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 E 54TH ST | ||||||||
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| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100225286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123717001 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2019 | ||||||||
| LastUpdateDate: | 11/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 012275 | CT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 11166298-2401 | UT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 045009-01 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.