1801617873 NPI number — SHIVAMKUMAR ANILBHAI PATEL PTA

Table of content: SHIVAMKUMAR ANILBHAI PATEL PTA (NPI 1801617873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801617873 NPI number — SHIVAMKUMAR ANILBHAI PATEL PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
SHIVAMKUMAR
Provider Middle Name:
ANILBHAI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801617873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2531 STEINWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASTORIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11103-3788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
929-506-7997
Provider Business Mailing Address Fax Number:
929-463-3149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1134 FLATBUSH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11226-6101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-218-8204
Provider Business Practice Location Address Fax Number:
929-542-1222
Provider Enumeration Date:
10/22/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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