Individual provider Active NPI

Shital Gautam Mistry, BACHELOR IN OT

  • Occupational Therapist
  • Monroe TWP, NJ
National Provider Identifier
1013130780
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
46TR00153100 Issued in NJ
Practice address
36 Eldorado Way
Monroe TWP, NJ 08831-4510
Phone
(732) 925-6567
NPI assigned
Apr 11, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 46TR00153100 NJ Primary

Addresses

Primary practice location

36 Eldorado Way
Monroe TWP, NJ 08831-4510

Mailing address

36 Eldorado Way
Monroe TWP, NJ 08831-4510
Phone (732) 925-6567

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013130780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 ELDORADO WAY",
            "city": "MONROE TWP",
            "state": "NJ",
            "postal_code": "088314510",
            "telephone_number": "732-925-6567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 ELDORADO WAY",
            "city": "MONROE TWP",
            "state": "NJ",
            "postal_code": "088314510",
            "telephone_number": "732-925-6567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISTRY",
        "first_name": "SHITAL",
        "middle_name": "GAUTAM",
        "credential": "BACHELOR IN OT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NJ",
            "license": "46TR00153100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe TWP, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.