Provider Demographics
NPI:1407746688
Name:BUCH, PHALAK PANKAJ
Entity type:Individual
Prefix:
First Name:PHALAK
Middle Name:PANKAJ
Last Name:BUCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 BEACON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1513
Mailing Address - Country:US
Mailing Address - Phone:201-850-0308
Mailing Address - Fax:
Practice Address - Street 1:1118 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-5578
Practice Address - Country:US
Practice Address - Phone:718-587-5791
Practice Address - Fax:718-587-5792
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist