Healthcare Provider Details

I. General information

NPI: 1740286111
Provider Name (Legal Business Name): ANIL S PATIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 ROUTE 109
LINDENHURST NY
11757-1158
US

IV. Provider business mailing address

118 BAGATELLE RD
MELVILLE NY
11747-4143
US

V. Phone/Fax

Practice location:
  • Phone: 631-546-5081
  • Fax:
Mailing address:
  • Phone: 631-546-5081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number213176
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number213176
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: