Provider Demographics
NPI:1003147109
Name:PATEL, BHARGAV DAMODAR (RPH)
Entity Type:Individual
Prefix:MR
First Name:BHARGAV
Middle Name:DAMODAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1473 AMSTERDAM AVE
Mailing Address - Street 2:STORE #1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7472
Mailing Address - Country:US
Mailing Address - Phone:212-491-4911
Mailing Address - Fax:212-491-4916
Practice Address - Street 1:1473 AMSTERDAM AVE
Practice Address - Street 2:STORE #1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7472
Practice Address - Country:US
Practice Address - Phone:212-491-4911
Practice Address - Fax:212-491-4916
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02263100183500000X
NY045639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist