Provider Demographics
NPI:1619393683
Name:THAKER, HEMISHA
Entity Type:Individual
Prefix:
First Name:HEMISHA
Middle Name:
Last Name:THAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEMISHA
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1014
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-1014
Mailing Address - Country:US
Mailing Address - Phone:732-855-9751
Mailing Address - Fax:732-855-9755
Practice Address - Street 1:3276 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1676
Practice Address - Country:US
Practice Address - Phone:732-238-8484
Practice Address - Fax:732-855-9755
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037440225100000X
NJ40QA01727800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist