Provider Demographics
NPI:1760775241
Name:MUKHERJEE, BHAIRVI (DPT)
Entity Type:Individual
Prefix:DR
First Name:BHAIRVI
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:BHAIRVI
Other - Middle Name:
Other - Last Name:MANDAVAWALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:60 COURT ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-7050
Mailing Address - Country:US
Mailing Address - Phone:848-628-4432
Mailing Address - Fax:
Practice Address - Street 1:60 COURT ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-7050
Practice Address - Country:US
Practice Address - Phone:848-628-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01376000225100000X
NY62032793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist