Healthcare Provider Details

I. General information

NPI: 1508509282
Provider Name (Legal Business Name): RAVI PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 9TH AVE
NEW YORK NY
10019-6336
US

IV. Provider business mailing address

775 9TH AVE
NEW YORK NY
10019-6336
US

V. Phone/Fax

Practice location:
  • Phone: 718-606-3863
  • Fax:
Mailing address:
  • Phone: 718-606-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number340287
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: