Provider Demographics
NPI:1922212109
Name:PATEL, ASHISH (PA-C)
Entity Type:Individual
Prefix:
First Name:ASHISH
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N BEDFORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2553
Mailing Address - Country:US
Mailing Address - Phone:914-244-8766
Mailing Address - Fax:
Practice Address - Street 1:721 CLIFTON AVE
Practice Address - Street 2:SUITE 2D
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1880
Practice Address - Country:US
Practice Address - Phone:973-473-5752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00075900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ124055RAJMedicare PIN