Provider Demographics
NPI:1124678776
Name:PATEL, KHANJANBEN SAUREEN
Entity type:Individual
Prefix:
First Name:KHANJANBEN
Middle Name:SAUREEN
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 CENTRAL PARK AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1059
Mailing Address - Country:US
Mailing Address - Phone:914-294-0080
Mailing Address - Fax:914-294-0079
Practice Address - Street 1:3163 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-3907
Practice Address - Country:US
Practice Address - Phone:914-294-0080
Practice Address - Fax:914-294-0079
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist