Provider Demographics
NPI:1194139303
Name:VITHALANI, VIDHI
Entity type:Individual
Prefix:
First Name:VIDHI
Middle Name:
Last Name:VITHALANI
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 1:685 SUMMIT AVE
Mailing Address - Street 2:APT#2
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2563
Mailing Address - Country:US
Mailing Address - Phone:201-417-1465
Mailing Address - Fax:
Practice Address - Street 1:1336 UTICA AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5912
Practice Address - Country:US
Practice Address - Phone:718-629-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist