Provider Demographics
NPI:1669737516
Name:DHANSUKH PATEL MD PC
Entity type:Organization
Organization Name:DHANSUKH PATEL MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-668-6140
Mailing Address - Street 1:11 PARK AVE
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2124
Mailing Address - Country:US
Mailing Address - Phone:914-668-6140
Mailing Address - Fax:
Practice Address - Street 1:45 LUDLOW ST
Practice Address - Street 2:SUITE 404
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-1947
Practice Address - Country:US
Practice Address - Phone:914-376-9349
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHANSUKH MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0030350534Medicaid
NY00595946Medicaid
NY00595946Medicaid