Provider Demographics
NPI:1760653117
Name:PATEL- PULIPATI, PINA R (MD)
Entity Type:Individual
Prefix:
First Name:PINA
Middle Name:R
Last Name:PATEL- PULIPATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PINA
Other - Middle Name:R
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:475 E MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3121
Mailing Address - Country:US
Mailing Address - Phone:631-654-2386
Mailing Address - Fax:631-447-3852
Practice Address - Street 1:475 E MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-654-2386
Practice Address - Fax:631-447-3852
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-13
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2662542084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program