Provider Demographics
NPI:1932317112
Name:PATEL, VRAJESH M (DO,)
Entity Type:Individual
Prefix:
First Name:VRAJESH
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COMMACK RD UNIT 204
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5022
Mailing Address - Country:US
Mailing Address - Phone:631-855-1200
Mailing Address - Fax:
Practice Address - Street 1:500 COMMACK RD UNIT 204
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5022
Practice Address - Country:US
Practice Address - Phone:631-855-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014824207R00000X
NMA-1494-09207R00000X
HI1256207R00000X
NY250164-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine