Provider Demographics
NPI:1932315678
Name:SRIVASTAVA, RATNESH KUMAR (OTR)
Entity Type:Individual
Prefix:
First Name:RATNESH
Middle Name:KUMAR
Last Name:SRIVASTAVA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JANCI CT
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2914
Mailing Address - Country:US
Mailing Address - Phone:732-549-6050
Mailing Address - Fax:973-762-6207
Practice Address - Street 1:333 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2491
Practice Address - Country:US
Practice Address - Phone:973-313-2104
Practice Address - Fax:973-762-6207
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00132200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist