Provider Demographics
NPI:1568902054
Name:PATEL, VIRALI (PA-C)
Entity Type:Individual
Prefix:
First Name:VIRALI
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BROADWAY
Mailing Address - Street 2:RM 1702
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4400
Mailing Address - Country:US
Mailing Address - Phone:908-510-5085
Mailing Address - Fax:
Practice Address - Street 1:150 BROADWAY
Practice Address - Street 2:SUITE NUMBER 1702
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4381
Practice Address - Country:US
Practice Address - Phone:917-409-7575
Practice Address - Fax:917-720-9037
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant