Provider Demographics
NPI:1881113280
Name:PATHAK, JAYASHREE SHRIKANT (MBBS(MD), C-IAYT)
Entity type:Individual
Prefix:DR
First Name:JAYASHREE
Middle Name:SHRIKANT
Last Name:PATHAK
Suffix:
Gender:F
Credentials:MBBS(MD), C-IAYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 HAMPTON LN
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2980
Mailing Address - Country:US
Mailing Address - Phone:404-316-1249
Mailing Address - Fax:
Practice Address - Street 1:385 TREMONT AVE
Practice Address - Street 2:VANJHCS, DEPARTMENT OF INTEGRATIVE MEDICINE
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018
Practice Address - Country:US
Practice Address - Phone:973-676-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-17
Last Update Date:2017-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
No174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
5815OtherMEDICAL COUNCIL OF MADHYA PRADESH, BHOPAL, 1984
38829497OtherTHE INTERNATIONAL ASSOCIATION OF YOGA THERAPISTS