Provider Demographics
NPI:1649802265
Name:PAHWA, RIDHIMA
Entity type:Individual
Prefix:DR
First Name:RIDHIMA
Middle Name:
Last Name:PAHWA
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 1:4 NELSON LN
Mailing Address - Street 2:
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9306
Mailing Address - Country:US
Mailing Address - Phone:973-303-1551
Mailing Address - Fax:
Practice Address - Street 1:123 HAWKINS PL UNIT K
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-1127
Practice Address - Country:US
Practice Address - Phone:973-299-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01835600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist