Provider Demographics
NPI:1225168222
Name:SHARMA, CHANDRAMOHAN (OTRCHT)
Entity Type:Individual
Prefix:MR
First Name:CHANDRAMOHAN
Middle Name:
Last Name:SHARMA
Suffix:
Gender:M
Credentials:OTRCHT
Other - Prefix:
Other - First Name:CHANDU
Other - Middle Name:
Other - Last Name:SHARMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:655 AMBOY AVE
Mailing Address - Street 2:D WING SUITE 1
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3159
Mailing Address - Country:US
Mailing Address - Phone:732-636-6632
Mailing Address - Fax:732-636-6637
Practice Address - Street 1:655 AMBOY AVE
Practice Address - Street 2:D WING SUITE 1
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-3159
Practice Address - Country:US
Practice Address - Phone:732-636-6632
Practice Address - Fax:732-636-6637
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00070300225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051034QA8Medicare PIN
NYCS0QU13810Medicare PIN
NYQU1381Medicare PIN