Provider Demographics
NPI:1982317483
Name:THAKKAR, GREESHMABEN BHIKHUBHAI
Entity Type:Individual
Prefix:
First Name:GREESHMABEN
Middle Name:BHIKHUBHAI
Last Name:THAKKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GREESHMA
Other - Middle Name:BHIKHABHAI
Other - Last Name:THAKKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3326 JOHN F KENNEDY BLVD APT 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4233
Mailing Address - Country:US
Mailing Address - Phone:704-953-7174
Mailing Address - Fax:
Practice Address - Street 1:2235 FREDERICK DOUGLASS BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-6175
Practice Address - Country:US
Practice Address - Phone:704-953-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist