Provider Demographics
NPI:1295155364
Name:PATEL, NEIL JITENDRA (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:JITENDRA
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3 COLT PL
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1101
Mailing Address - Country:US
Mailing Address - Phone:347-735-6345
Mailing Address - Fax:
Practice Address - Street 1:101 NICHOLLS ROAD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-3244
Practice Address - Country:US
Practice Address - Phone:631-444-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH205882084N0400X
FLME1452242084N0400X
NY2912812084N0400X, 2084S0010X
CAA1568292084S0010X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0010XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySports Medicine