Provider Demographics
NPI:1851568091
Name:SUDHA PATEL MD PLLC
Entity Type:Organization
Organization Name:SUDHA PATEL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUDHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
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 PKWY
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 PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-15
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129033208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00548861Medicaid
NY0143156OtherGHI
NY0143156OtherGHI
NY00548861Medicaid