Provider Demographics
NPI:1649425539
Name:PATEL, PALLAVI KALPESH (OTR)
Entity type:Individual
Prefix:MRS
First Name:PALLAVI
Middle Name:KALPESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24902 JERICHO TPKE STE 205
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-4000
Mailing Address - Country:US
Mailing Address - Phone:516-775-9777
Mailing Address - Fax:516-775-9777
Practice Address - Street 1:24902 JERICHO TPKE STE 205
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-4000
Practice Address - Country:US
Practice Address - Phone:718-926-8994
Practice Address - Fax:718-939-8364
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013810252Y00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0127188Medicaid