MEDICARE: NIKULKUMAR ASHWINBHAI 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	039201	NY
2	225100000X	Physical Therapist	40QA01872300	NJ

General Provider Information

NPI Number	:	1295190262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKULKUMAR ASHWINBHAI PATEL

Provider Business Mailing Address
First Line	:	2098 ROCKAWAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W FRONT ST STE B1
Second Line	:
City	:	PLAINFIELD
State	:	NJ
Zip	:	07060-1173
Country	:	US
Telephone Number	:	845-384-0818
Fax Number	:	845-384-0819

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

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	12/09/2025

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