MEDICARE: SAMIR JITENDRABHAI PATEL PTA

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	225200000X	Physical Therapy Assistant	015171	NY

General Provider Information

NPI Number	:	1225971393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMIR JITENDRABHAI PATEL PTA

Provider Business Mailing Address
First Line	:	4249 COLDEN ST APT 5M
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-3908
Country	:	US
Telephone Number	:	347-845-3661
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 W 45TH ST FL 9
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-4905
Country	:	US
Telephone Number	:	212-867-1111
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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