Provider Demographics
NPI:1578537304
Name:PATEL, MUKUND R (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKUND
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:35 ANNFIELD CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1301
Mailing Address - Country:US
Mailing Address - Phone:718-979-1552
Mailing Address - Fax:718-979-0023
Practice Address - Street 1:4901 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-3345
Practice Address - Country:US
Practice Address - Phone:718-435-4944
Practice Address - Fax:718-435-1249
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114030207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00208580Medicaid
NY00208580Medicaid
NYB8000BMedicare UPIN