Provider Demographics
NPI:1740238682
Name:PATEL, SURENDRA C (MD)
Entity Type:Individual
Prefix:
First Name:SURENDRA
Middle Name:C
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 1:2525 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2258
Mailing Address - Country:US
Mailing Address - Phone:718-351-3132
Mailing Address - Fax:718-980-6819
Practice Address - Street 1:2525 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2258
Practice Address - Country:US
Practice Address - Phone:718-351-3132
Practice Address - Fax:718-980-6819
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60125227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD34175Medicare UPIN
NY334322Medicare ID - Type Unspecified