Provider Demographics
NPI:1740605021
Name:MAHIMKAR, AMRITA DUTTRAJ
Entity type:Individual
Prefix:
First Name:AMRITA
Middle Name:DUTTRAJ
Last Name:MAHIMKAR
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 1:11 HEDGEROW LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-7905
Mailing Address - Country:US
Mailing Address - Phone:347-462-4876
Mailing Address - Fax:347-435-2111
Practice Address - Street 1:11 HEDGEROW LN
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-7905
Practice Address - Country:US
Practice Address - Phone:347-462-4876
Practice Address - Fax:347-435-2111
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036907-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist