Provider Demographics
NPI:1114299617
Name:PATEL, DIPTI DEVENDRAKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:DIPTI
Middle Name:DEVENDRAKUMAR
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1743 NORTH OCEAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763
Mailing Address - Country:US
Mailing Address - Phone:631-758-3100
Mailing Address - Fax:631-758-2026
Practice Address - Street 1:3001 EXPRESSWAY DRIVE NORTH
Practice Address - Street 2:STE. 104
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749
Practice Address - Country:US
Practice Address - Phone:631-435-0110
Practice Address - Fax:631-435-4583
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY269949-1207R00000X, 204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine