Provider Demographics
NPI:1871529701
Name:TAWALARE, SUDHIR VYANKATRAO (PT)
Entity type:Individual
Prefix:MR
First Name:SUDHIR
Middle Name:VYANKATRAO
Last Name:TAWALARE
Suffix:
Gender:M
Credentials:PT
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Mailing Address - Street 1:281 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1017
Mailing Address - Country:US
Mailing Address - Phone:201-782-9455
Mailing Address - Fax:201-782-9455
Practice Address - Street 1:275 N MIDDLETOWN RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1188
Practice Address - Country:US
Practice Address - Phone:845-623-6566
Practice Address - Fax:845-623-6556
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY012255-12251H1200X, 2251X0800X
NJQA 059482251H1200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ042333Medicare ID - Type Unspecified
NYQ19Z51Medicare ID - Type Unspecified