Provider Demographics
NPI:1770530065
Name:PATEL, LALIT POPATLAL (MD)
Entity type:Individual
Prefix:
First Name:LALIT
Middle Name:POPATLAL
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 1:15 CHAFFEE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1807
Mailing Address - Country:US
Mailing Address - Phone:516-477-0511
Mailing Address - Fax:516-248-3895
Practice Address - Street 1:360 A 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4008
Practice Address - Country:US
Practice Address - Phone:718-499-6000
Practice Address - Fax:718-499-6004
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232725207R00000X
NJMA78631207R00000X
CAA86251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02648231Medicaid
NYI25414Medicare UPIN
NY078SM1Medicare ID - Type Unspecified