Healthcare Provider Details

I. General information

NPI: 1588808232
Provider Name (Legal Business Name): PUJA PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2009
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE 4TH FLOOR
BRONX NY
10467-2403
US

IV. Provider business mailing address

3415 BAINBRIDGE AVE FL 4
BRONX NY
10467-2403
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4738
  • Fax:
Mailing address:
  • Phone: 187-920-4378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number263120
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number263120
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number263120
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: