MEDICARE: DIPIKA 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	010925	NY

General Provider Information

NPI Number	:	1861014102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIPIKA PATEL PTA

Provider Business Mailing Address
First Line	:	288A CLARENDON ST
Second Line	:
City	:	SECAUCUS
State	:	NJ
Zip	:	07094-3304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 BROOK AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-2508
Country	:	US
Telephone Number	:	347-590-6565
Fax Number	:

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

Provider Enumeration Date	:	05/09/2020
Last Update Date	:	05/09/2020

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Directions to “ DIPIKA PATEL PTA” Practice Location

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