Provider Demographics
NPI:1609815604
Name:GAGLANI, AMIT ANIL (PT)
Entity Type:Individual
Prefix:MR
First Name:AMIT
Middle Name:ANIL
Last Name:GAGLANI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2562
Mailing Address - Country:US
Mailing Address - Phone:732-494-0895
Mailing Address - Fax:732-494-0896
Practice Address - Street 1:3830 PARK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2562
Practice Address - Country:US
Practice Address - Phone:732-494-0895
Practice Address - Fax:732-494-0896
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00819800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ047934TN4Medicare PIN