Provider Demographics
NPI:1598531915
Name:RAIKUNDLIA, HETANSHI RAJESH (PT)
Entity Type:Individual
Prefix:
First Name:HETANSHI RAJESH
Middle Name:
Last Name:RAIKUNDLIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3788
Mailing Address - Country:US
Mailing Address - Phone:929-463-7104
Mailing Address - Fax:929-463-3149
Practice Address - Street 1:1021 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-5263
Practice Address - Country:US
Practice Address - Phone:929-480-0783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050402-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist