Provider Demographics
NPI:1346614377
Name:VEDPATHAK, SUMANT (PT)
Entity Type:Individual
Prefix:
First Name:SUMANT
Middle Name:
Last Name:VEDPATHAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 RYDERS LN
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08850-1353
Mailing Address - Country:US
Mailing Address - Phone:914-328-8077
Mailing Address - Fax:914-328-6079
Practice Address - Street 1:907 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4301
Practice Address - Country:US
Practice Address - Phone:718-589-9588
Practice Address - Fax:718-589-9589
Is Sole Proprietor?:No
Enumeration Date:2015-11-13
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist