Provider Demographics
NPI:1568661817
Name:PATEL, ALKA S (DDS)
Entity Type:Individual
Prefix:
First Name:ALKA
Middle Name:S
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LAKE RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CONGERS
Mailing Address - State:NY
Mailing Address - Zip Code:10920-2251
Mailing Address - Country:US
Mailing Address - Phone:845-268-3304
Mailing Address - Fax:845-268-3349
Practice Address - Street 1:1 LAKE RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CONGERS
Practice Address - State:NY
Practice Address - Zip Code:10920-2251
Practice Address - Country:US
Practice Address - Phone:845-268-3304
Practice Address - Fax:845-268-3349
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01743168Medicaid