Healthcare Provider Details

I. General information

NPI: 1225971393
Provider Name (Legal Business Name): SAMIR JITENDRABHAI PATEL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13618 39TH AVE STE 704
FLUSHING NY
11354-5583
US

IV. Provider business mailing address

4249 COLDEN ST APT 5M
FLUSHING NY
11355-3908
US

V. Phone/Fax

Practice location:
  • Phone: 917-602-5414
  • Fax:
Mailing address:
  • Phone: 917-602-5414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number055831
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: