MEDICARE: MISS MARIUM ANEES 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	2251P0200X	Pediatric Physical Therapist	037636	NY

General Provider Information

NPI Number	:	1861865032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIUM ANEES PATEL

Provider Business Mailing Address
First Line	:	221 E 18TH ST
Second Line	:	APT 3K
City	:	BROOKLYN
State	:	NY
Zip	:	11226-4763
Country	:	US
Telephone Number	:	585-743-0054
Fax Number	:

Provider Business Practice Location Address
First Line	:	2212 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-3535
Country	:	US
Telephone Number	:	212-988-9500
Fax Number	:

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

Provider Enumeration Date	:	11/10/2015
Last Update Date	:	11/10/2015

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