Provider Demographics
NPI:1629207907
Name:PATEL, NIKI (MD)
Entity Type:Individual
Prefix:
First Name:NIKI
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3924
Mailing Address - Country:US
Mailing Address - Phone:478-955-2226
Mailing Address - Fax:718-204-7470
Practice Address - Street 1:2015 AMSTERDAM AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5013
Practice Address - Country:US
Practice Address - Phone:478-955-2226
Practice Address - Fax:718-204-7470
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003577207R00000X
CT053823207R00000X
NY278307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400157154Medicare Oscar/Certification