Provider Demographics
NPI:1164742912
Name:PATEL, SHALIN JITENDRA (MD)
Entity Type:Individual
Prefix:
First Name:SHALIN
Middle Name:JITENDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1351 ROUTE 55
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-5108
Mailing Address - Country:US
Mailing Address - Phone:845-475-9661
Mailing Address - Fax:845-475-9938
Practice Address - Street 1:365 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-331-5165
Practice Address - Fax:845-331-6238
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2018-09-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY283731207RC0000X, 207UN0901X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04496773Medicaid
NY04496773Medicaid