Healthcare Provider Details

I. General information

NPI: 1295272441
Provider Name (Legal Business Name): NISHI GARG PATEL DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 12/07/2024
Certification Date: 12/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 8TH AVE
NEW YORK NY
10011-5108
US

IV. Provider business mailing address

320 W 38TH ST APT 216
NEW YORK NY
10018-5215
US

V. Phone/Fax

Practice location:
  • Phone: 212-406-3686
  • Fax:
Mailing address:
  • Phone: 630-926-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number019.030639
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number060642-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: