Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251H1200X | Hand | 012255-1 | NY |
N | 2251H1200X | Hand | QA 05948 | NJ |
Y | 2251X0800X | Physical Therapist - Orthopedic | 012255-1 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | QA 05948 | NJ |
NPI | 1871529701 |
---|---|
Provider Name | Mr. Sudhir Vyankatrao Tawalare |
First Address | Park Ridge, NJ 07656-1017 |
Second Address | Pearl River, NY 10965-1188 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 09/12/2015 |