Provider Demographics
NPI:1255681516
Name:PATEL, RAVIKUMAR VISHNUBHAI
Entity type:Individual
Prefix:
First Name:RAVIKUMAR
Middle Name:VISHNUBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 ZABRISKIE ST
Mailing Address - Street 2:BASEMENT
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-3711
Mailing Address - Country:US
Mailing Address - Phone:201-539-6077
Mailing Address - Fax:
Practice Address - Street 1:83 ZABRISKIE ST
Practice Address - Street 2:BASEMENT
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07307-3711
Practice Address - Country:US
Practice Address - Phone:201-539-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008230-1225200000X
NY035667225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant