Provider Demographics
NPI:1366577371
Name:DIKSHIT, NAMRATA NIMESH (MAPT)
Entity type:Individual
Prefix:MS
First Name:NAMRATA
Middle Name:NIMESH
Last Name:DIKSHIT
Suffix:
Gender:F
Credentials:MAPT
Other - Prefix:
Other - First Name:NAMRATA
Other - Middle Name:NIMESH
Other - Last Name:DIXIT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAPT
Mailing Address - Street 1:1030 SAINT GEORGES AVE STE LL3
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1330
Mailing Address - Country:US
Mailing Address - Phone:732-404-1040
Mailing Address - Fax:732-404-1041
Practice Address - Street 1:1030 SAINT GEORGES AVE STE LL3
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1330
Practice Address - Country:US
Practice Address - Phone:732-404-1040
Practice Address - Fax:732-404-1041
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00062952251H1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman Factors
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ154028Medicare PIN