Healthcare Provider Details

I. General information

NPI: 1740570738
Provider Name (Legal Business Name): NIMA P. PATEL M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 SUTTON PL
NEW YORK NY
10022-2429
US

IV. Provider business mailing address

4878 37TH ST
LONG ISLAND CITY NY
11101-1904
US

V. Phone/Fax

Practice location:
  • Phone: 212-486-2720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number255682-1
License Number StateNY

VIII. Authorized Official

Name: NIMA PRAFUL PATEL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-200-0935