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General NPI Number Information
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NPI Number | 1588922926
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Entity Type | Individual
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Provider Name | DR. PRATIK MANSUKH MAVANI
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Gender | Male
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 132 S 10TH ST SUITE 1099J
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City | PHILADELPHIA
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State | PA
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Zip | 19107
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Country | US
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Telephone | 215-955-6028
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Fax |
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Provider Business Mailing Address
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Address Line | 13 BEDFORD DR
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City | MATAWAN
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State | NJ
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Zip | 07747-6660
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Country | US
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Telephone | 973-262-2764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 293152
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License Number State | NY
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