MEDICARE: MISS PALAK VISHNU PATEL 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	023978-1	NY

General Provider Information

NPI Number	:	1649397589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PALAK VISHNU PATEL PT

Provider Business Mailing Address
First Line	:	10828 63RD DR
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1410
Country	:	US
Telephone Number	:	718-938-1474
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 E 23RD ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-4516
Country	:	US
Telephone Number	:	212-677-7400
Fax Number	:	212-982-5268

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

Provider Enumeration Date	:	03/24/2007
Last Update Date	:	07/08/2007

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