Provider Demographics
NPI:1639153752
Name:PATEL, DHANSUKHLAL MANILAL (MD)
Entity Type:Individual
Prefix:
First Name:DHANSUKHLAL
Middle Name:MANILAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DHANSUKH
Other - Middle Name:MANILAL
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11 PARK AVE
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2124
Mailing Address - Country:US
Mailing Address - Phone:914-668-6140
Mailing Address - Fax:914-663-8745
Practice Address - Street 1:11 PARK AVE
Practice Address - Street 2:SUITE 1K
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2124
Practice Address - Country:US
Practice Address - Phone:914-668-6140
Practice Address - Fax:914-663-8745
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00595946Medicaid
NY51A721Medicare PIN
NY00595946Medicaid
NY51A722Medicare PIN