Provider Demographics
NPI:1336191220
Name:PATEL, MAYANK (MD)
Entity Type:Individual
Prefix:
First Name:MAYANK
Middle Name:
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 1:25602 HILLSIDE AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1618
Mailing Address - Country:US
Mailing Address - Phone:718-343-3535
Mailing Address - Fax:718-343-7272
Practice Address - Street 1:25602 HILLSIDE AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1618
Practice Address - Country:US
Practice Address - Phone:718-343-3535
Practice Address - Fax:718-343-7272
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203392207P00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01679845Medicaid
NY01679845Medicaid
NY65049LMedicare ID - Type Unspecified