Provider Demographics
NPI:1235906595
Name:SEVAK, NEHAL ASHISH (PTA)
Entity Type:Individual
Prefix:
First Name:NEHAL
Middle Name:ASHISH
Last Name:SEVAK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 STUART ST
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4519
Mailing Address - Country:US
Mailing Address - Phone:917-991-2833
Mailing Address - Fax:
Practice Address - Street 1:162 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-1033
Practice Address - Country:US
Practice Address - Phone:201-768-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00151900225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty