Provider Demographics
NPI:1528343076
Name:PATEL, MANTHAN (PT)
Entity type:Individual
Prefix:
First Name:MANTHAN
Middle Name:
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 1:145 PIERMONT RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1022
Mailing Address - Country:US
Mailing Address - Phone:201-568-3355
Mailing Address - Fax:210-568-3350
Practice Address - Street 1:145 PIERMONT RD
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1022
Practice Address - Country:US
Practice Address - Phone:201-568-3355
Practice Address - Fax:210-568-3350
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033846225100000X
NJ40QA01474800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist