Provider Demographics
NPI:1851679153
Name:PATEL, JAINISHABEN M (PT)
Entity type:Individual
Prefix:
First Name:JAINISHABEN
Middle Name:M
Last Name:PATEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JAINISHA
Other - Middle Name:M
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:277 LIBERTY AVE
Mailing Address - Street 2:APT # 5
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07307-4426
Mailing Address - Country:US
Mailing Address - Phone:732-900-4916
Mailing Address - Fax:
Practice Address - Street 1:632 BROADWAY
Practice Address - Street 2:SUITE # 303
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2614
Practice Address - Country:US
Practice Address - Phone:732-900-4916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033195-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist