MEDICARE: DR. NISHI PATEL DDS

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	1223G0001X	General Practice Dentistry	0580101	NY

General Provider Information

NPI Number	:	1831515329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISHI PATEL DDS

Provider Business Mailing Address
First Line	:	39 WARNER RD
Second Line	:
City	:	HUNTINGTON
State	:	NY
Zip	:	11743-5918
Country	:	US
Telephone Number	:	301-204-1089
Fax Number	:

Provider Business Practice Location Address
First Line	:	492 OLD TOWN RD
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-2249
Country	:	US
Telephone Number	:	631-928-1018
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2014
Last Update Date	:	09/30/2019

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