Provider Demographics
NPI:1073033957
Name:AGARWAL, NAMRATA DEEPESH (MPT)
Entity type:Individual
Prefix:
First Name:NAMRATA
Middle Name:DEEPESH
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:NAMRATA
Other - Middle Name:VIJAY
Other - Last Name:CHANDAVARKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:31 RIVER CT APT 3512
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07310-2040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5920 VAN DOREN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11368-4018
Practice Address - Country:US
Practice Address - Phone:718-592-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0411692251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology