Provider Demographics
NPI:1205997731
Name:PATEL, NIMA (PT DPT)
Entity type:Individual
Prefix:DR
First Name:NIMA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 ROUTE 18 STE 3
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3797
Mailing Address - Country:US
Mailing Address - Phone:908-227-4927
Mailing Address - Fax:732-372-4285
Practice Address - Street 1:1447 ROUTE 18 STE 3
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3797
Practice Address - Country:US
Practice Address - Phone:908-227-4927
Practice Address - Fax:732-372-4285
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01227800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ158773BC1Medicare PIN