Provider Demographics
NPI:1689654220
Name:PATEL, BABU (MD)
Entity Type:Individual
Prefix:
First Name:BABU
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 1:1963A DALY AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-2803
Mailing Address - Country:US
Mailing Address - Phone:718-991-8300
Mailing Address - Fax:718-542-7077
Practice Address - Street 1:1963A DALY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2803
Practice Address - Country:US
Practice Address - Phone:718-991-8300
Practice Address - Fax:718-542-7077
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01986992Medicaid
NY01986992Medicaid
NY796641Medicare PIN