Healthcare Provider Details

I. General information

NPI: 1700885738
Provider Name (Legal Business Name): SURYAKANT Z PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 N 2ND ST
FULTON NY
13069-1250
US

IV. Provider business mailing address

21 N 2ND ST
FULTON NY
13069-1250
US

V. Phone/Fax

Practice location:
  • Phone: 315-598-7105
  • Fax: 315-598-4857
Mailing address:
  • Phone: 315-598-7105
  • Fax: 315-598-4857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number132393
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: