Provider Demographics
NPI:1770103343
Name:PATEL, SAMARTH (MD)
Entity type:Individual
Prefix:
First Name:SAMARTH
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 1:14 SUSAN DR
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2315
Mailing Address - Country:US
Mailing Address - Phone:201-921-1839
Mailing Address - Fax:
Practice Address - Street 1:1963A DALY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-2803
Practice Address - Country:US
Practice Address - Phone:718-999-1830
Practice Address - Fax:718-542-7077
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334162207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine