Provider Demographics
NPI:1508234683
Name:TRIVEDI, ANUJA HEMANG (OTR/L)
Entity Type:Individual
Prefix:
First Name:ANUJA
Middle Name:HEMANG
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 BANTA ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1918
Mailing Address - Country:US
Mailing Address - Phone:201-803-7008
Mailing Address - Fax:201-786-9222
Practice Address - Street 1:537 BANTA ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-1918
Practice Address - Country:US
Practice Address - Phone:201-803-7008
Practice Address - Fax:201-786-9222
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018433225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY018433OtherLICENSE