Provider Demographics
NPI:1760089494
Name:DHIMAR, MIHIR (PTA)
Entity Type:Individual
Prefix:
First Name:MIHIR
Middle Name:
Last Name:DHIMAR
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 NEWARK AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2306
Mailing Address - Country:US
Mailing Address - Phone:718-377-5000
Mailing Address - Fax:718-377-5002
Practice Address - Street 1:634 NEWARK AVE FL 3
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2306
Practice Address - Country:US
Practice Address - Phone:718-377-5000
Practice Address - Fax:718-377-5002
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010820225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant