Provider Demographics
NPI:1508828849
Name:PATEL, JITENDRA R (MD)
Entity Type:Individual
Prefix:
First Name:JITENDRA
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:1050 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3627
Practice Address - Country:US
Practice Address - Phone:718-816-6440
Practice Address - Fax:718-816-3795
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2019-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY158745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00959215Medicaid
NY00959215Medicaid
24D971Medicare ID - Type Unspecified