Provider Demographics
NPI:1033566831
Name:SODAWALA, CHANDNI (DPT)
Entity Type:Individual
Prefix:
First Name:CHANDNI
Middle Name:
Last Name:SODAWALA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 W 57TH ST STE 603
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2810
Mailing Address - Country:US
Mailing Address - Phone:212-757-1333
Mailing Address - Fax:212-757-6333
Practice Address - Street 1:57 W 57TH ST STE 603
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:212-757-1333
Practice Address - Fax:212-757-6333
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-21
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62039940261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1033566831Medicaid