Provider Demographics
NPI:1922295799
Name:PATEL, RATTAN MAHENDRAKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RATTAN
Middle Name:MAHENDRAKUMAR
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 1:430 67TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-4903
Mailing Address - Country:US
Mailing Address - Phone:718-213-1416
Mailing Address - Fax:
Practice Address - Street 1:9602 4TH AVE APT 4L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7820
Practice Address - Country:US
Practice Address - Phone:718-680-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10200000207RC0200X, 207RI0200X, 207R00000X
NY265750207RC0200X, 207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03526285Medicaid
NYA100166972Medicare UPIN
NY03526285Medicaid
NYA100166972Medicare PIN