Healthcare Provider Details

I. General information

NPI: 1457525271
Provider Name (Legal Business Name): SRP DENTAL CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 E KINGSBRIDGE RD
BRONX NY
10468-7514
US

IV. Provider business mailing address

250 W CLARKSTOWN RD
NEW CITY NY
10956-7221
US

V. Phone/Fax

Practice location:
  • Phone: 718-933-9603
  • Fax: 718-866-0337
Mailing address:
  • Phone: 718-933-9603
  • Fax: 718-866-0337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. SURENDRA R PATEL
Title or Position: OWNER/PRESIDENT
Credential: DDS
Phone: 718-933-9603