Provider Demographics
NPI:1033547344
Name:PANCHAL, UTPAL M (PT)
Entity Type:Individual
Prefix:
First Name:UTPAL
Middle Name:M
Last Name:PANCHAL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-1900
Mailing Address - Country:US
Mailing Address - Phone:862-899-7900
Mailing Address - Fax:862-899-7901
Practice Address - Street 1:372 AVENUE U
Practice Address - Street 2:SUITE LL3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4018
Practice Address - Country:US
Practice Address - Phone:718-372-1690
Practice Address - Fax:718-372-1691
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist