Healthcare Provider Details

I. General information

NPI: 1013837319
Provider Name (Legal Business Name): PRIYA BHAVESHBHAI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 PARKSIDE AVE STE 201
BROOKLYN NY
11226-8414
US

IV. Provider business mailing address

640 PARKSIDE AVE STE 201
BROOKLYN NY
11226-8414
US

V. Phone/Fax

Practice location:
  • Phone: 212-867-1111
  • Fax: 718-587-1891
Mailing address:
  • Phone: 718-587-1889
  • Fax: 718-587-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number015170
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: