Provider Demographics
NPI:1235298456
Name:PATEL, PADMESH (RPH)
Entity Type:Individual
Prefix:MR
First Name:PADMESH
Middle Name:
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 1:675 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4957
Mailing Address - Country:US
Mailing Address - Phone:718-387-2665
Mailing Address - Fax:718-486-8314
Practice Address - Street 1:675 GRAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-4957
Practice Address - Country:US
Practice Address - Phone:718-387-2665
Practice Address - Fax:718-486-8314
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048918-1183500000X
NJ02564200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02825381Medicaid