Provider Demographics
NPI:1982949004
Name:RAJDERKAR, NAMRATA (PT)
Entity Type:Individual
Prefix:
First Name:NAMRATA
Middle Name:
Last Name:RAJDERKAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 STAFFORD TER
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4035
Mailing Address - Country:US
Mailing Address - Phone:201-716-9628
Mailing Address - Fax:
Practice Address - Street 1:5758 BERKSHIRE VALLEY RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07438-9847
Practice Address - Country:US
Practice Address - Phone:973-697-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032433225100000X
NJ40QA01555000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400080410Medicare PIN
NYA400080404Medicare PIN
NYG400084237Medicare PIN