Healthcare Provider Details

I. General information

NPI: 1962825778
Provider Name (Legal Business Name): RONAK PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE MILSTEIN 4A
BRONX NY
10457-7606
US

IV. Provider business mailing address

1504 TAUB LOOP
HOUSTON TX
77030-1608
US

V. Phone/Fax

Practice location:
  • Phone: 914-645-0064
  • Fax:
Mailing address:
  • Phone: 713-798-1750
  • Fax: 713-798-4693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number288903
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT5429
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: