Provider Demographics
NPI:1649431669
Name:DIWAN, AMBIKA (PT, MBA)
Entity type:Individual
Prefix:MRS
First Name:AMBIKA
Middle Name:
Last Name:DIWAN
Suffix:
Gender:F
Credentials:PT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 US HIGHWAY 130
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-2600
Mailing Address - Country:US
Mailing Address - Phone:609-632-2129
Mailing Address - Fax:609-632-2131
Practice Address - Street 1:572 US HIGHWAY 130
Practice Address - Street 2:SUITE 4
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2600
Practice Address - Country:US
Practice Address - Phone:609-632-2129
Practice Address - Fax:609-632-2131
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002798225100000X
NJ400QA008675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist