Provider Demographics
NPI:1568646461
Name:PATEL, PRAVINABEN SURESH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:PRAVINABEN
Middle Name:SURESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-1033
Mailing Address - Country:US
Mailing Address - Phone:845-469-2916
Mailing Address - Fax:845-469-6462
Practice Address - Street 1:89 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1033
Practice Address - Country:US
Practice Address - Phone:845-469-2916
Practice Address - Fax:845-469-6462
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01448122Medicaid