Provider Demographics
NPI:1598984668
Name:PATEL, KEYOOR (DO, FACC)
Entity Type:Individual
Prefix:DR
First Name:KEYOOR
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 LEWIS RD
Mailing Address - Street 2:STE 2
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-1040
Mailing Address - Country:US
Mailing Address - Phone:607-763-6580
Mailing Address - Fax:607-763-6782
Practice Address - Street 1:30 HARRISON ST STE 250
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2176
Practice Address - Country:US
Practice Address - Phone:607-770-8600
Practice Address - Fax:607-770-0853
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY244015207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03379288Medicaid
NY03379288Medicaid