Provider Demographics
NPI:1811232671
Name:PATEL, KINJALBAHEN DIPEN (PT)
Entity Type:Individual
Prefix:
First Name:KINJALBAHEN
Middle Name:DIPEN
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-5000
Mailing Address - Country:US
Mailing Address - Phone:914-328-8077
Mailing Address - Fax:914-328-6083
Practice Address - Street 1:907 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4301
Practice Address - Country:US
Practice Address - Phone:718-589-9588
Practice Address - Fax:718-589-9589
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01558500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG400084061Medicare PIN
NYA400081282Medicare PIN
NYA400081438Medicare PIN