Healthcare Provider Details

I. General information

NPI: 1194575431
Provider Name (Legal Business Name): MONIKA PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 KNICKERBOCKER AVE # 2ND
BROOKLYN NY
11237-4102
US

IV. Provider business mailing address

9607 E LAUREL LN
SCOTTSDALE AZ
85260-5957
US

V. Phone/Fax

Practice location:
  • Phone: 718-573-3333
  • Fax:
Mailing address:
  • Phone: 480-543-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number064828-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: