Provider Demographics
NPI:1598563439
Name:PATWA, SANJANA
Entity type:Individual
Prefix:
First Name:SANJANA
Middle Name:
Last Name:PATWA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29A CLIFF ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3469
Mailing Address - Country:US
Mailing Address - Phone:346-575-7908
Mailing Address - Fax:
Practice Address - Street 1:8616 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5182
Practice Address - Country:US
Practice Address - Phone:718-833-4656
Practice Address - Fax:718-833-4348
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP13337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist