Provider Demographics
NPI:1134350788
Name:BHARDWAJ, KASHMIRA K (PT)
Entity type:Individual
Prefix:
First Name:KASHMIRA
Middle Name:K
Last Name:BHARDWAJ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BARTLE CT
Mailing Address - Street 2:APT D
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-6027
Mailing Address - Country:US
Mailing Address - Phone:203-927-6961
Mailing Address - Fax:
Practice Address - Street 1:32 BARTLE CT
Practice Address - Street 2:APT D
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-6027
Practice Address - Country:US
Practice Address - Phone:203-927-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-30
Last Update Date:2009-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01267200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ123Medicaid
NJ123Medicaid