Basic Information
Provider Information
NPI: 1922731751
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PATEL
FirstName: SHIKHA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1014
Address2:  
City: CLARK
State: NJ
PostalCode: 070661014
CountryCode: US
TelephoneNumber: 7328559751
FaxNumber:  
Practice Location
Address1: 2625 MORRIS AVE
Address2:  
City: UNION
State: NJ
PostalCode: 070835606
CountryCode: US
TelephoneNumber: 9082762626
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/08/2022
LastUpdateDate: 07/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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