MEDICARE: CHARMI KETANKUMAR PATEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	055328	NY

General Provider Information

NPI Number	:	1104613041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARMI KETANKUMAR PATEL

Provider Business Mailing Address
First Line	:	710 GRAND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-5140
Country	:	US
Telephone Number	:	929-888-9681
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 GRAND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11211-5140
Country	:	US
Telephone Number	:	929-888-9681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	02/18/2026

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Directions to “ CHARMI KETANKUMAR PATEL ” Practice Location

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