Basic Information
| Provider Information | |||||||||
| NPI: | 1972020949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | PURVI | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1311 MAMARONECK AVE STE 140 | ||||||||
| Address2: | |||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106055224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888304125 | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 NORTH AVE E STE 1 | ||||||||
| Address2: | |||||||||
| City: | CRANFORD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070162491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082760237 | ||||||||
| FaxNumber: | 9082765692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2017 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 46TR00672700 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 021659-1 | 01 | NY | NEW YORK STATE LICENSE | OTHER |