Provider Demographics
NPI:1679350573
Name:SUTARIYA, HARDIK GHANSHYAMBHAI (MS, PT)
Entity Type:Individual
Prefix:
First Name:HARDIK
Middle Name:GHANSHYAMBHAI
Last Name:SUTARIYA
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 SUMMIT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2501
Mailing Address - Country:US
Mailing Address - Phone:862-348-1206
Mailing Address - Fax:
Practice Address - Street 1:3960 FLATLANDS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3043
Practice Address - Country:US
Practice Address - Phone:718-258-8128
Practice Address - Fax:718-258-2073
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty