Provider Demographics
NPI:1609083211
Name:MEHRROSTAMI, MEHRBANOO (PT)
Entity Type:Individual
Prefix:MRS
First Name:MEHRBANOO
Middle Name:
Last Name:MEHRROSTAMI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MEHRBANOO
Other - Middle Name:
Other - Last Name:POULAD-NOSHIRAVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:451 MINE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:BERNARDSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07924-2007
Mailing Address - Country:US
Mailing Address - Phone:201-793-8988
Mailing Address - Fax:
Practice Address - Street 1:451 MINE BROOK RD
Practice Address - Street 2:
Practice Address - City:BERNARDSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07924-2007
Practice Address - Country:US
Practice Address - Phone:201-793-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022651225100000X, 2251E1200X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQQ6611Medicare ID - Type Unspecified