MEDICARE: DR. PALVI PATEL DPT,MA, BS

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	172V00000X	Community Health Worker	026329-1	NY
2	225100000X	Physical Therapist	026329-1	NY

General Provider Information

NPI Number	:	1760628556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PALVI PATEL DPT,MA, BS

Provider Business Mailing Address
First Line	:	11 ST JAMES ST
Second Line	:
City	:	MONROE TOWNSHIP
State	:	NJ
Zip	:	08831-8681
Country	:	US
Telephone Number	:	347-885-8813
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 JEFFERSON BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-3329
Country	:	US
Telephone Number	:	929-284-3318
Fax Number	:

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

Provider Enumeration Date	:	12/28/2008
Last Update Date	:	12/13/2021

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