Healthcare Provider Details

I. General information

NPI: 1033179080
Provider Name (Legal Business Name): NILESH PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 JAMAICA AVE 1ST FLOOR
JAMAICA NY
11418-2619
US

IV. Provider business mailing address

13420 JAMAICA AVE 1ST FLOOR
JAMAICA NY
11418-2619
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-6742
  • Fax: 718-206-6905
Mailing address:
  • Phone: 718-206-6742
  • Fax: 718-206-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number193421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: