Provider Demographics
NPI:1679557292
Name:PATEL, PRAVIN P (MD,)
Entity Type:Individual
Prefix:DR
First Name:PRAVIN
Middle Name:P
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 1:67 STEPHENS DR
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-6110
Mailing Address - Country:US
Mailing Address - Phone:914-316-2851
Mailing Address - Fax:
Practice Address - Street 1:3455 BOSTON RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-2508
Practice Address - Country:US
Practice Address - Phone:718-798-2236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00689125Medicaid
NY05D501Medicare ID - Type Unspecified
NY00689125Medicaid