Healthcare Provider Details

I. General information

NPI: 1447241583
Provider Name (Legal Business Name): RAJNI P PATEL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PIONEER TRL
ARMONK NY
10504-1500
US

IV. Provider business mailing address

5 PIONEER TRL
ARMONK NY
10504-1500
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-6946
  • Fax: 718-292-6525
Mailing address:
  • Phone: 718-292-6946
  • Fax: 718-292-6525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number034563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: