Provider Demographics
NPI:1548592231
Name:PATEL, SUNIL B (RPH)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:B
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 1:14 ANTHONY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1467
Mailing Address - Country:US
Mailing Address - Phone:908-222-9093
Mailing Address - Fax:
Practice Address - Street 1:494 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3248
Practice Address - Country:US
Practice Address - Phone:718-485-6923
Practice Address - Fax:718-922-3287
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY36192OtherNEW YORK STATE LICENCE