Provider Demographics
NPI:1619209608
Name:JAIN, KHUSHBU (PT)
Entity Type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:
Last Name:JAIN
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 1:23 ROBERT PITT DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952
Mailing Address - Country:US
Mailing Address - Phone:845-517-2652
Mailing Address - Fax:845-517-2654
Practice Address - Street 1:23 ROBERT PITT DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3373
Practice Address - Country:US
Practice Address - Phone:845-517-2652
Practice Address - Fax:845-517-2654
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032214-1163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation