Provider Demographics
NPI:1689856403
Name:SUDHA PATEL MD PLLC
Entity Type:Organization
Organization Name:SUDHA PATEL MD PLLC
Other - Org Name:SUDHA PATEL M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-236-6025
Mailing Address - Street 1:1835 BAY RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5706
Mailing Address - Country:US
Mailing Address - Phone:718-236-6025
Mailing Address - Fax:718-236-6391
Practice Address - Street 1:1835 BAY RIDGE PARKWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5706
Practice Address - Country:US
Practice Address - Phone:718-236-6025
Practice Address - Fax:718-236-6391
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUDHA PATEL MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129033261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0008818OtherGHI
NY171260OtherELDERPLAN
NY6C0182OtherHEALTHNET
NYM4070POtherHIP
NY328641OtherMEDICARE
NY392382OtherCONNECTICARE
NY00548861Medicaid
NYP2042835OtherOXFORD
NY328641OtherMEDICARE
NY=========OtherCIGNA
NY00548861Medicaid
NY=========OtherUNITED HEALTHCARE