Healthcare Provider Details

I. General information

NPI: 1790110617
Provider Name (Legal Business Name): JANKI N PATEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 EASTON AVE
SOMERSET NJ
08873-1613
US

IV. Provider business mailing address

36 PRESTON ST
EDISON NJ
08817-3925
US

V. Phone/Fax

Practice location:
  • Phone: 732-246-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number40QA01463200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA01463200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: