Provider Demographics
NPI:1255865986
Name:MAKWANA, VIVEKKUMAR C (PT)
Entity Type:Individual
Prefix:
First Name:VIVEKKUMAR
Middle Name:C
Last Name:MAKWANA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:83 JEFFERSON AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2116
Mailing Address - Country:US
Mailing Address - Phone:978-228-9104
Mailing Address - Fax:888-908-8284
Practice Address - Street 1:2752 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4706
Practice Address - Country:US
Practice Address - Phone:718-484-8765
Practice Address - Fax:718-484-8766
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY041359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY041359OtherLICENSE