Provider Demographics
NPI:1801966809
Name:PATEL, PINA (PT)
Entity type:Individual
Prefix:MS
First Name:PINA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 71ST AVE
Mailing Address - Street 2:SUITE LL 1
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4564
Mailing Address - Country:US
Mailing Address - Phone:718-268-6072
Mailing Address - Fax:718-268-0226
Practice Address - Street 1:10850 71ST AVE
Practice Address - Street 2:SUITE LL 1
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4564
Practice Address - Country:US
Practice Address - Phone:718-268-6072
Practice Address - Fax:718-268-0226
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0273761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ27J31Medicare ID - Type Unspecified