Provider Demographics
NPI:1477762722
Name:SHILPA S. DEWOOLKAR
Entity Type:Organization
Organization Name:SHILPA S. DEWOOLKAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHILPA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEWOOLKAR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR,CHT
Authorized Official - Phone:201-343-3644
Mailing Address - Street 1:155 POLIFLY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1749
Mailing Address - Country:US
Mailing Address - Phone:201-343-3644
Mailing Address - Fax:201-343-1770
Practice Address - Street 1:155 POLIFLY RD STE 104
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1749
Practice Address - Country:US
Practice Address - Phone:201-343-3644
Practice Address - Fax:201-343-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00069000332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4697100001Medicare NSC
NJ038256Medicare PIN