Provider Demographics
NPI:1821481987
Name:PATEL, TARAK
Entity Type:Individual
Prefix:
First Name:TARAK
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 MCDONALD AVE
Mailing Address - Street 2:SUITE # 143
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-804-9636
Practice Address - Street 1:5928 LITTLE NECK PKWY
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-2532
Practice Address - Country:US
Practice Address - Phone:182-240-0566
Practice Address - Fax:718-224-7544
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283051-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry