Provider Demographics
NPI:1396142071
Name:PATEL, PRIYANKA TUSHAR I
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:TUSHAR
Last Name:PATEL
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PRIYANKA
Other - Middle Name:T
Other - Last Name:PATEL
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5933 162ND ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1418
Mailing Address - Country:US
Mailing Address - Phone:347-545-6458
Mailing Address - Fax:
Practice Address - Street 1:59 33 162 STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11365
Practice Address - Country:US
Practice Address - Phone:347-545-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047192-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist