Healthcare Provider Details

I. General information

NPI: 1457790859
Provider Name (Legal Business Name): SMITA CHIRAG PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST PH 15
NEW YORK NY
10032
US

IV. Provider business mailing address

720 W 170TH ST APT 5H
NEW YORK NY
10032-2954
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5697
  • Fax:
Mailing address:
  • Phone: 610-680-7318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number289872
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: