Healthcare Provider Details

I. General information

NPI: 1174672240
Provider Name (Legal Business Name): PREMIER MEDICAL ASSOCIATE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1873 PATTERSON AVE
BRONX NY
10473-3039
US

IV. Provider business mailing address

1873 PATTERSON AVE
BRONX NY
10473-3039
US

V. Phone/Fax

Practice location:
  • Phone: 718-589-2799
  • Fax: 718-328-6839
Mailing address:
  • Phone: 718-589-2799
  • Fax: 718-328-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number236025
License Number StateNY

VIII. Authorized Official

Name: DR. HITESH BABUBHAI PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 718-589-2799