Provider Demographics
NPI:1669410775
Name:PATEL, JITENDRA K (MD)
Entity type:Individual
Prefix:
First Name:JITENDRA
Middle Name:K
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 1:3 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:718-258-7019
Mailing Address - Fax:718-692-3772
Practice Address - Street 1:3420 AVENUE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2607
Practice Address - Country:US
Practice Address - Phone:718-258-7019
Practice Address - Fax:718-692-3772
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY155137207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00785108Medicaid
01D871Medicare ID - Type Unspecified
NY00785108Medicaid