Provider Demographics
NPI:1396837191
Name:PATEL, RAJESH J (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2106 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457
Mailing Address - Country:US
Mailing Address - Phone:718-367-3930
Mailing Address - Fax:718-364-5121
Practice Address - Street 1:2106 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-367-3930
Practice Address - Fax:718-364-5121
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY163097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00897269Medicaid
A63276Medicare UPIN
NY00897269Medicaid