Provider Demographics
NPI:1033179619
Name:PATEL, AMI A (MD)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:A
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 CLINTONVILLE ST STE 1C
Mailing Address - Street 2:#30
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1849
Mailing Address - Country:US
Mailing Address - Phone:312-343-2444
Mailing Address - Fax:201-266-9090
Practice Address - Street 1:5301 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2622
Practice Address - Country:US
Practice Address - Phone:201-866-9320
Practice Address - Fax:201-266-9090
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07628900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0079685Medicaid
I14317Medicare UPIN
NJ0079685Medicaid
NJ086468UM6Medicare PIN