Provider Demographics
NPI:1205066248
Name:TRIVEDI, SMITABEN
Entity type:Individual
Prefix:
First Name:SMITABEN
Middle Name:
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CHARDON CT
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4439
Mailing Address - Country:US
Mailing Address - Phone:732-772-1525
Mailing Address - Fax:
Practice Address - Street 1:3499 US HIGHWAY 9 NORTH JUNIPER PLAZA STE 3D
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3258
Practice Address - Country:US
Practice Address - Phone:732-772-1525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-24
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00591200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist