Provider Demographics
NPI:1912543984
Name:SHINDE, PRITI PRAVIN
Entity Type:Individual
Prefix:
First Name:PRITI PRAVIN
Middle Name:
Last Name:SHINDE
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 1:220 HARMON COVE TOWER
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-1729
Mailing Address - Country:US
Mailing Address - Phone:917-935-7155
Mailing Address - Fax:
Practice Address - Street 1:240 E 54TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-5286
Practice Address - Country:US
Practice Address - Phone:212-371-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT012275225100000X
UT11166298-2401225100000X
NY045009-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist