Provider Demographics
NPI:1174782890
Name:PATEL, JALDIP SHANTIBHAI (PT)
Entity type:Individual
Prefix:
First Name:JALDIP
Middle Name:SHANTIBHAI
Last Name:PATEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 FOUNTAYNE LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2679
Mailing Address - Country:US
Mailing Address - Phone:313-702-3888
Mailing Address - Fax:
Practice Address - Street 1:897 US HIGHWAY 130
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-2907
Practice Address - Country:US
Practice Address - Phone:313-702-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01392000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist