Provider Demographics
NPI:1265703748
Name:GOKHALE, VAISHALI CHANDRASHEKHAR (RPT)
Entity type:Individual
Prefix:
First Name:VAISHALI
Middle Name:CHANDRASHEKHAR
Last Name:GOKHALE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6730 150TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1424
Mailing Address - Country:US
Mailing Address - Phone:718-463-8883
Mailing Address - Fax:718-463-8880
Practice Address - Street 1:6730 150TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1424
Practice Address - Country:US
Practice Address - Phone:718-463-8883
Practice Address - Fax:718-463-8880
Is Sole Proprietor?:No
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034351-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY034351-1OtherLICENSE