Provider Demographics
NPI:1851761175
Name:PATEL, PRIYA SAILESH (PA-C)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:SAILESH
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 JOHN ST RM 1450
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-3122
Mailing Address - Country:US
Mailing Address - Phone:212-204-6501
Mailing Address - Fax:212-204-6501
Practice Address - Street 1:111 JOHN ST RM 1450
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3122
Practice Address - Country:US
Practice Address - Phone:212-204-6501
Practice Address - Fax:212-791-5704
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00377200363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical