Provider Demographics
NPI:1780323493
Name:VASAVADA, PARTH UMESHBHAI
Entity type:Individual
Prefix:
First Name:PARTH
Middle Name:UMESHBHAI
Last Name:VASAVADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4137
Mailing Address - Country:US
Mailing Address - Phone:216-778-0275
Mailing Address - Fax:
Practice Address - Street 1:3400 CANNON PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4302
Practice Address - Country:US
Practice Address - Phone:718-796-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY046482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist