Provider Demographics
NPI:1528176203
Name:BASRA, RITUDEEP
Entity type:Individual
Prefix:
First Name:RITUDEEP
Middle Name:
Last Name:BASRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RITU
Other - Middle Name:
Other - Last Name:BASRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3 STEPHENVILLE PKWY
Mailing Address - Street 2:STE 2C
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3061
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 STEPHENVILLE PKWY
Practice Address - Street 2:STE 2C
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3061
Practice Address - Country:US
Practice Address - Phone:908-293-8636
Practice Address - Fax:908-552-3558
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00722300OtherLICENSE #