Provider Demographics
NPI:1497041776
Name:PATEL, TEJAS BHARAT (MD)
Entity Type:Individual
Prefix:DR
First Name:TEJAS
Middle Name:BHARAT
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 1:4107 S WATER TOWER PL
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-6784
Mailing Address - Country:US
Mailing Address - Phone:929-200-3003
Mailing Address - Fax:929-224-0696
Practice Address - Street 1:2955 VETERANS RD W STE 2F
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2504
Practice Address - Country:US
Practice Address - Phone:929-200-3003
Practice Address - Fax:929-224-0696
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282042207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4426651Medicaid