Provider Demographics
NPI:1215507579
Name:PANDYA, VIVEKI (PT)
Entity type:Individual
Prefix:
First Name:VIVEKI
Middle Name:
Last Name:PANDYA
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 1:1132 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-5350
Mailing Address - Country:US
Mailing Address - Phone:609-937-4851
Mailing Address - Fax:
Practice Address - Street 1:684 W FINGERBOARD RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2630
Practice Address - Country:US
Practice Address - Phone:718-442-1003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist