Provider Demographics
NPI:1326829169
Name:GOHEL, BHOOMESH S
Entity Type:Individual
Prefix:
First Name:BHOOMESH
Middle Name:S
Last Name:GOHEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BEACON WAY APT 1104
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07304-6136
Mailing Address - Country:US
Mailing Address - Phone:216-688-5207
Mailing Address - Fax:
Practice Address - Street 1:20 BEACON WAY APT 1104
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-6136
Practice Address - Country:US
Practice Address - Phone:216-688-5207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-09
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty