Provider Demographics
NPI:1205672516
Name:RAOLE, YASH ABHAY
Entity type:Individual
Prefix:
First Name:YASH
Middle Name:ABHAY
Last Name:RAOLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 FIAT AVE
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-1418
Mailing Address - Country:US
Mailing Address - Phone:732-423-5697
Mailing Address - Fax:
Practice Address - Street 1:2163 OAK TREE RD STE 109
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1084
Practice Address - Country:US
Practice Address - Phone:732-272-0083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02261900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist