Provider Demographics
NPI:1497767404
Name:PATEL, SANDIP G (PT)
Entity Type:Individual
Prefix:
First Name:SANDIP
Middle Name:G
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 1:230 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-3343
Mailing Address - Country:US
Mailing Address - Phone:973-964-5070
Mailing Address - Fax:
Practice Address - Street 1:1655 OAK TREE RD
Practice Address - Street 2:STE 295A
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2849
Practice Address - Country:US
Practice Address - Phone:732-902-6910
Practice Address - Fax:732-902-6911
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016976225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist