Provider Demographics
NPI:1316582000
Name:TRIVEDI, KHUSHALI (PT)
Entity Type:Individual
Prefix:
First Name:KHUSHALI
Middle Name:
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 MILL ST UNIT H3
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-5306
Mailing Address - Country:US
Mailing Address - Phone:973-759-1494
Mailing Address - Fax:973-759-0557
Practice Address - Street 1:902 N 5TH ST STE C104
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-4804
Practice Address - Country:US
Practice Address - Phone:973-910-2300
Practice Address - Fax:973-910-2300
Is Sole Proprietor?:No
Enumeration Date:2019-11-17
Last Update Date:2019-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01893400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist