Provider Demographics
NPI:1639753965
Name:AHIR, JIVANBHAI JASHUBHAI
Entity Type:Individual
Prefix:
First Name:JIVANBHAI
Middle Name:JASHUBHAI
Last Name:AHIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 W 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2812
Mailing Address - Country:US
Mailing Address - Phone:718-265-2222
Mailing Address - Fax:718-333-1023
Practice Address - Street 1:2876 W 27TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2812
Practice Address - Country:US
Practice Address - Phone:718-265-2222
Practice Address - Fax:718-333-1023
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY047005OtherREGISTRATION CERTIFICATE