Healthcare Provider Details

I. General information

NPI: 1114019700
Provider Name (Legal Business Name): ALLAMPRABHU SAHEBGOUDA PATIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COUNTRY MEADOW CT
MELVILLE NY
11747-2026
US

IV. Provider business mailing address

1 COUNTRY MEADOW CT
MELVILLE NY
11747-2026
US

V. Phone/Fax

Practice location:
  • Phone: 631-367-6427
  • Fax: 631-367-6234
Mailing address:
  • Phone: 516-586-6330
  • Fax: 516-586-6326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number179697
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number179697
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number179697
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number179697
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number179697
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number179697
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number179697
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: