Healthcare Provider Details

I. General information

NPI: 1316908171
Provider Name (Legal Business Name): SANJIVAN PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

374 STOCKHOLM STREET
BROOKLYN NY
11237
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-6479
  • Fax: 718-963-6793
Mailing address:
  • Phone: 718-963-6485
  • Fax: 718-963-6793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number167729
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number167729
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: