Provider Demographics
NPI:1316258635
Name:PATEL, RAKESHKUMAR JOITARAM (PT)
Entity type:Individual
Prefix:
First Name:RAKESHKUMAR
Middle Name:JOITARAM
Last Name:PATEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4803
Mailing Address - Country:US
Mailing Address - Phone:914-328-8077
Mailing Address - Fax:914-328-6083
Practice Address - Street 1:1970 ADAM CLAYTON POWELL JR BLVD (7TH AVE)
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1723
Practice Address - Country:US
Practice Address - Phone:212-864-1500
Practice Address - Fax:212-864-0500
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400031635Medicare PIN
NYA400032256Medicare PIN
NYA400032255Medicare PIN
NYA400032257Medicare PIN