Provider Demographics
NPI:1225707680
Name:BHATT, JYOTIBEN JIGAR
Entity Type:Individual
Prefix:
First Name:JYOTIBEN
Middle Name:JIGAR
Last Name:BHATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3103
Mailing Address - Country:US
Mailing Address - Phone:718-909-9089
Mailing Address - Fax:
Practice Address - Street 1:53 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-3103
Practice Address - Country:US
Practice Address - Phone:718-909-9089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04331401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy