Provider Demographics
NPI:1568460343
Name:PATEL, RAKESH B (MD)
Entity Type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:B
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 1:48 ROUTE 25A
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1431
Mailing Address - Country:US
Mailing Address - Phone:631-784-7373
Mailing Address - Fax:631-784-7359
Practice Address - Street 1:48 ROUTE 25A
Practice Address - Street 2:SUITE 103
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1431
Practice Address - Country:US
Practice Address - Phone:631-784-7373
Practice Address - Fax:631-784-7359
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204473-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02155782Medicaid
NYG69184Medicare UPIN
NY02155782Medicaid