Healthcare Provider Details

I. General information

NPI: 1033029897
Provider Name (Legal Business Name): SHIVANI KAMLESH PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 KINDERKAMACK RD
RIVER EDGE NJ
07661-2140
US

IV. Provider business mailing address

576 BROADHOLLOW RD
MELVILLE NY
11747-5012
US

V. Phone/Fax

Practice location:
  • Phone: 201-992-0174
  • Fax:
Mailing address:
  • Phone: 631-359-5800
  • Fax: 631-396-0864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: