Provider Demographics
NPI:1003061490
Name:LEVITT, TEJAL GORDHAN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:DR
First Name:TEJAL
Middle Name:GORDHAN
Last Name:LEVITT
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 CONSTITUTION WAY
Mailing Address - Street 2:APT. 106
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-5431
Mailing Address - Country:US
Mailing Address - Phone:609-213-2441
Mailing Address - Fax:
Practice Address - Street 1:40 CONSTITUTION WAY
Practice Address - Street 2:APT. 106
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-5431
Practice Address - Country:US
Practice Address - Phone:609-213-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist