Healthcare Provider Details

I. General information

NPI: 1255681516
Provider Name (Legal Business Name): RAVIKUMAR VISHNUBHAI PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 ZABRISKIE ST BASEMENT
JERSEY CITY NJ
07307-3711
US

IV. Provider business mailing address

83 ZABRISKIE ST BASEMENT
JERSEY CITY NJ
07307-3711
US

V. Phone/Fax

Practice location:
  • Phone: 201-539-6077
  • Fax:
Mailing address:
  • Phone: 201-539-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number035667
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number008230-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: