Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 035781 | NY |
Y | 225100000X | Physical Therapist | 40QA01599200 | NJ |
NPI | 1003152265 |
---|---|
Provider Name | Vidisha Shah |
First Address | Jersey City, NJ 07310-1400 |
Second Address | Jersey City, NJ 07310-1400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2012 |
Last Update Date | 05/03/2020 |