Provider Demographics
NPI:1326384157
Name:PATEL, PAYAL T (BPT)
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:T
Last Name:PATEL
Suffix:
Gender:F
Credentials:BPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 PAVONIA AVE
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-5216
Mailing Address - Country:US
Mailing Address - Phone:404-483-5386
Mailing Address - Fax:
Practice Address - Street 1:902 PAVONIA AVE
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-5216
Practice Address - Country:US
Practice Address - Phone:404-483-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist