MEDICARE: KHANJANBEN SAUREEN PATEL

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	044941	NY

General Provider Information

NPI Number	:	1124678776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHANJANBEN SAUREEN PATEL

Provider Business Mailing Address
First Line	:	1254 CENTRAL PARK AVE STE 3
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10704-1059
Country	:	US
Telephone Number	:	914-294-0080
Fax Number	:	914-294-0079

Provider Business Practice Location Address
First Line	:	3163 BAINBRIDGE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-3907
Country	:	US
Telephone Number	:	914-294-0080
Fax Number	:	914-294-0079

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

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	09/16/2019

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