Provider Demographics
NPI:1902202542
Name:PHATAK, SNEHA
Entity Type:Individual
Prefix:MRS
First Name:SNEHA
Middle Name:
Last Name:PHATAK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SWATI
Other - Middle Name:SUDHIR
Other - Last Name:JAMADAGNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:575 8TH AVE
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:575 8TH AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018
Practice Address - Country:US
Practice Address - Phone:917-286-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018814-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist