Basic Information
Provider Information
NPI: 1003003088
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VORA
FirstName: AVANI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3228 STATE ROUTE 27
Address2: SUITE 2A
City: KENDALL PARK
State: NJ
PostalCode: 088241524
CountryCode: US
TelephoneNumber: 7322970032
FaxNumber:  
Practice Location
Address1: 3228 STATE ROUTE 27
Address2: SUITE 2A
City: KENDALL PARK
State: NJ
PostalCode: 088241524
CountryCode: US
TelephoneNumber: 7322970032
FaxNumber: 7322970558
Other Information
ProviderEnumerationDate: 10/03/2007
LastUpdateDate: 10/03/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X40QA01254500NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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