Provider Demographics
NPI:1629839568
Name:PATTAN, YAKUB SAMEERKHAN (PT, MS)
Entity Type:Individual
Prefix:
First Name:YAKUB SAMEERKHAN
Middle Name:
Last Name:PATTAN
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 95TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2506
Mailing Address - Country:US
Mailing Address - Phone:716-275-7634
Mailing Address - Fax:
Practice Address - Street 1:68 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-6705
Practice Address - Country:US
Practice Address - Phone:718-566-8277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist