Provider Demographics
NPI:1972679942
Name:PATEL, SUNIL AMBALAL (MD)
Entity Type:Individual
Prefix:
First Name:SUNIL
Middle Name:AMBALAL
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SUNILKUMAR
Other - Middle Name:AMBALAL
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2315 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-6623
Mailing Address - Country:US
Mailing Address - Phone:718-447-6900
Mailing Address - Fax:718-477-7862
Practice Address - Street 1:2315 VICTORY BOULEVARD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:718-477-6900
Practice Address - Fax:718-477-7862
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204466207R00000X
NJ25MA07014500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP501593OtherOXFORD
NY01729648Medicaid
NY2506992OtherGHI
NYP501593OtherOXFORD
NYG43594Medicare UPIN