Provider Demographics
NPI:1922467828
Name:PATEL, REEMABEN
Entity Type:Individual
Prefix:
First Name:REEMABEN
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15A SHERIDAN VLG APT 4
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-1427
Mailing Address - Country:US
Mailing Address - Phone:518-881-9748
Mailing Address - Fax:
Practice Address - Street 1:115 SARATOGA RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12302-4211
Practice Address - Country:US
Practice Address - Phone:518-264-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019493363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical