MEDICARE: UTPAL M PANCHAL PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	034382	NY

General Provider Information

NPI Number	:	1033547344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UTPAL M PANCHAL PT

Provider Business Mailing Address
First Line	:	246 CLIFTON AVE
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07011-1900
Country	:	US
Telephone Number	:	862-899-7900
Fax Number	:	862-899-7901

Provider Business Practice Location Address
First Line	:	372 AVENUE U
Second Line	:	SUITE LL3
City	:	BROOKLYN
State	:	NY
Zip	:	11223-4018
Country	:	US
Telephone Number	:	718-372-1690
Fax Number	:	718-372-1691

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2013
Last Update Date	:	06/17/2021

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