Provider Demographics
NPI:1194425868
Name:MANSURI, ROOHIJAHAN MAKSUDBHAI
Entity type:Individual
Prefix:
First Name:ROOHIJAHAN
Middle Name:MAKSUDBHAI
Last Name:MANSURI
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 1:111 HUTTON ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3016
Mailing Address - Country:US
Mailing Address - Phone:361-228-6731
Mailing Address - Fax:
Practice Address - Street 1:506 LENOX AVE RM 3137
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1889
Practice Address - Country:US
Practice Address - Phone:121-293-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049978-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist