Provider Demographics
NPI:1790840833
Name:PATEL, RASIK L (MD)
Entity Type:Individual
Prefix:
First Name:RASIK
Middle Name:L
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 1:3250 3RD AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-6743
Mailing Address - Country:US
Mailing Address - Phone:718-893-1250
Mailing Address - Fax:
Practice Address - Street 1:3250 3RD AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6743
Practice Address - Country:US
Practice Address - Phone:718-893-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198627207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02059676Medicaid
NY52C191Medicare ID - Type Unspecified
NY02059676Medicaid