Healthcare Provider Details

I. General information

NPI: 1699823930
Provider Name (Legal Business Name): BALDEVBHAI VITHALDAS PATEL PHYSICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 08/22/2020
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: 718-294-0700
  • 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 Number
License Number State

VIII. Authorized Official

Name: DR. BALDEVBHAI V PATEL
Title or Position: OFFICER
Credential:
Phone: 516-652-2700