Provider Demographics
NPI:1649747445
Name:KHANGAR, SONALI R
Entity Type:Individual
Prefix:
First Name:SONALI
Middle Name:R
Last Name:KHANGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 BEACON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2102
Mailing Address - Country:US
Mailing Address - Phone:909-653-6948
Mailing Address - Fax:
Practice Address - Street 1:3100 47TH AVE STE 2120
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-3010
Practice Address - Country:US
Practice Address - Phone:909-653-6948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041557-12251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty