Healthcare Provider Details

I. General information

NPI: 1285719633
Provider Name (Legal Business Name): JAGDISH G PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MMG - BRONX EAST 2300 WESTCHESTER AVENUE
BRONX NY
10462
US

IV. Provider business mailing address

2300 WESTCHESTER AVE
BRONX NY
10462-5072
US

V. Phone/Fax

Practice location:
  • Phone: 718-597-2962
  • Fax:
Mailing address:
  • Phone: 718-829-1900
  • Fax: 718-597-2962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number133971
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: