Provider Demographics
NPI:1700885738
Name:PATEL, SURYAKANT Z (MD)
Entity Type:Individual
Prefix:DR
First Name:SURYAKANT
Middle Name:Z
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 1:21 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-1250
Mailing Address - Country:US
Mailing Address - Phone:315-598-7105
Mailing Address - Fax:315-598-4857
Practice Address - Street 1:21 N 2ND ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1250
Practice Address - Country:US
Practice Address - Phone:315-598-7105
Practice Address - Fax:315-598-4857
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132393173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00582825Medicaid
NY00582825Medicaid
NYBB7879Medicare ID - Type UnspecifiedMEDICARE PROVIDER #