Provider Demographics
NPI:1124018130
Name:PATEL, PARAG P (DMD)
Entity Type:Individual
Prefix:DR
First Name:PARAG
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E 44TH ST
Mailing Address - Street 2:#1801
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4400
Mailing Address - Country:US
Mailing Address - Phone:646-242-8774
Mailing Address - Fax:
Practice Address - Street 1:770 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4101
Practice Address - Country:US
Practice Address - Phone:718-299-1800
Practice Address - Fax:718-299-1801
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY484811223G0001X
CA479851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02050466Medicaid