Provider Demographics
NPI:1578692380
Name:DR.NINA S. PATEL DDS., P.C.
Entity Type:Organization
Organization Name:DR.NINA S. PATEL DDS., P.C.
Other - Org Name:FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR(DENTIST)
Authorized Official - Prefix:DR
Authorized Official - First Name:NINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-355-0155
Mailing Address - Street 1:22 S TYSON AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2017
Mailing Address - Country:US
Mailing Address - Phone:516-355-0155
Mailing Address - Fax:516-355-0157
Practice Address - Street 1:22 S TYSON AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2017
Practice Address - Country:US
Practice Address - Phone:516-355-0155
Practice Address - Fax:516-355-0157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048437-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02187988Medicaid
NY02187988Medicaid