Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 40QA01544900 | NJ |
NPI | 1386183556 |
---|---|
Provider Name | Hetal Desai |
First Address | Rahway, NJ 07065-4949 |
Second Address | Rahway, NJ 07065-4949 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2017 |
Last Update Date | 21/02/2017 |