Provider Demographics
NPI:1457595191
Name:PATEL, MANISH G (DO)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:G
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 1:12 MAPLE AVE
Mailing Address - Street 2:DEPT OF ANESTHESIOLOGY
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990
Mailing Address - Country:US
Mailing Address - Phone:845-986-5175
Mailing Address - Fax:
Practice Address - Street 1:12 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-1320
Practice Address - Country:US
Practice Address - Phone:845-986-5175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 10809207L00000X
NY252059-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology