Provider Demographics
NPI:1255331591
Name:PATEL, ASVIN (MD)
Entity Type:Individual
Prefix:MR
First Name:ASVIN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-2903
Mailing Address - Country:US
Mailing Address - Phone:516-938-0020
Mailing Address - Fax:516-938-5569
Practice Address - Street 1:71 N BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-2903
Practice Address - Country:US
Practice Address - Phone:516-938-0020
Practice Address - Fax:516-938-5569
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NY159052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB11359Medicare UPIN
24D091Medicare ID - Type Unspecified