Provider Demographics
NPI:1467711440
Name:RANWADKAR, PALLAVI (PT, OCS)
Entity Type:Individual
Prefix:
First Name:PALLAVI
Middle Name:
Last Name:RANWADKAR
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 STEPHENVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2615
Mailing Address - Country:US
Mailing Address - Phone:315-601-2144
Mailing Address - Fax:844-444-1160
Practice Address - Street 1:1856 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2704
Practice Address - Country:US
Practice Address - Phone:908-208-7271
Practice Address - Fax:844-444-1160
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032622225100000X
NJ40QA01537900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1467711440OtherNPI
NYA400069948Medicare PIN
NYA400070581Medicare PIN
NYA400073829Medicare PIN
NYA400071406Medicare PIN