Provider Demographics
NPI:1457578635
Name:HAJARE, POONAM (OTR)
Entity Type:Individual
Prefix:MISS
First Name:POONAM
Middle Name:
Last Name:HAJARE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 PRIMITIVO CT
Mailing Address - Street 2:APT# A-2
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-4128
Mailing Address - Country:US
Mailing Address - Phone:716-348-9580
Mailing Address - Fax:
Practice Address - Street 1:77 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7330
Practice Address - Country:US
Practice Address - Phone:973-540-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00420000225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ46TR00420000OtherOCCUPATIONAL THERAPY LIC