Provider Demographics
NPI:1649966359
Name:KAMSANI, DIVYABHARATHI
Entity type:Individual
Prefix:
First Name:DIVYABHARATHI
Middle Name:
Last Name:KAMSANI
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 1:59 LIBERTY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5070
Mailing Address - Country:US
Mailing Address - Phone:201-920-5401
Mailing Address - Fax:
Practice Address - Street 1:59 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5070
Practice Address - Country:US
Practice Address - Phone:201-920-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045361225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist