Provider Demographics
NPI:1225354558
Name:PATEL, GOPALBHAI AMBALAL (PT)
Entity Type:Individual
Prefix:
First Name:GOPALBHAI
Middle Name:AMBALAL
Last Name:PATEL
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 1:14118 79TH AVE
Mailing Address - Street 2:3F
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3663
Mailing Address - Country:US
Mailing Address - Phone:347-279-6837
Mailing Address - Fax:
Practice Address - Street 1:856 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-1402
Practice Address - Country:US
Practice Address - Phone:718-919-1000
Practice Address - Fax:718-919-9700
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032516225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400030251Medicare PIN
NYA400030407Medicare PIN
NYA400030203Medicare PIN
NYA400026332Medicare PIN