Healthcare Provider Details

I. General information

NPI: 1023194891
Provider Name (Legal Business Name): ASHVINBHAI DESAIBHAI PATEL M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 GERARD AVE
BRONX NY
10452-8001
US

IV. Provider business mailing address

8231 265TH ST
FLORAL PARK NY
11004-1718
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-2753
  • Fax: 718-960-2868
Mailing address:
  • Phone: 718-960-2753
  • Fax: 718-960-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number110120
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: