Healthcare Provider Details

I. General information

NPI: 1295155364
Provider Name (Legal Business Name): NEIL JITENDRA PATEL MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W 45TH ST FL 21
NEW YORK NY
10036-4041
US

IV. Provider business mailing address

3 COLT PL
OLD WESTBURY NY
11568-1101
US

V. Phone/Fax

Practice location:
  • Phone: 313-887-0960
  • Fax:
Mailing address:
  • Phone: 347-735-6345
  • Fax: 516-689-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number291281
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License NumberA156829
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License Number291281
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA156829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: