Healthcare Provider Details

I. General information

NPI: 1336296623
Provider Name (Legal Business Name): BALDEVBHAI V. PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 UNIVERSITY AVE
BRONX NY
10453
US

IV. Provider business mailing address

51 STONE HILL DRIVE SOUTH
MANHASSET NY
11030
US

V. Phone/Fax

Practice location:
  • Phone: 719-294-0700
  • Fax: 718-901-1150
Mailing address:
  • Phone: 516-652-2700
  • Fax: 718-901-1150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number161386
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: