Provider Demographics
NPI:1326233040
Name:MAVANI, YOGINI (DO)
Entity type:Individual
Prefix:
First Name:YOGINI
Middle Name:
Last Name:MAVANI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 HARRISON ST STE 212F
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6087
Mailing Address - Country:US
Mailing Address - Phone:917-412-3423
Mailing Address - Fax:201-484-8952
Practice Address - Street 1:50 HARRISON ST
Practice Address - Street 2:STE 212F
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6087
Practice Address - Country:US
Practice Address - Phone:201-484-8950
Practice Address - Fax:201-484-8952
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08207400208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ505047Medicare PIN