Provider Demographics
NPI:1083720460
Name:DEWOOLKAR, SHILPA SANTOSH (OTRL CHT)
Entity Type:Individual
Prefix:MS
First Name:SHILPA
Middle Name:SANTOSH
Last Name:DEWOOLKAR
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 POLIFLY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1758
Mailing Address - Country:US
Mailing Address - Phone:201-343-3644
Mailing Address - Fax:201-343-1770
Practice Address - Street 1:155 POLIFLY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1758
Practice Address - Country:US
Practice Address - Phone:201-343-3644
Practice Address - Fax:201-343-1770
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00069000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
038256Medicare ID - Type Unspecified