MEDICARE: SUDHA PATEL MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	129033	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	328641	OTHER	NY	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0008818	OTHER	NY	GHI
2	171260	OTHER	NY	ELDERPLAN
3	6C0182	OTHER	NY	HEALTHNET
4	M4070P	OTHER	NY	HIP
6	392382	OTHER	NY	CONNECTICARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	P2042835	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1689856403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUDHA PATEL MD PLLC

Provider Business Mailing Address
First Line	:	1835 BAY RIDGE PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5706
Country	:	US
Telephone Number	:	718-236-6025
Fax Number	:	718-236-6391

Provider Business Practice Location Address
First Line	:	1835 BAY RIDGE PARKWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5706
Country	:	US
Telephone Number	:	718-236-6025
Fax Number	:	718-236-6391

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUDHA P. PATEL
Credential	:	M.D.
Telephone Number	:	718-236-6025

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	04/20/2008

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Directions to “SUDHA PATEL MD PLLC ” Practice Location

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