Provider Demographics
NPI:1952766321
Name:RAZ SHACHAR, NETTA
Entity Type:Individual
Prefix:
First Name:NETTA
Middle Name:
Last Name:RAZ SHACHAR
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 1:67 EDGEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2909
Mailing Address - Country:US
Mailing Address - Phone:646-226-8677
Mailing Address - Fax:
Practice Address - Street 1:67 EDGEWOOD ST
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2909
Practice Address - Country:US
Practice Address - Phone:646-226-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0376551225100000X
NJ40QA02097400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist