Healthcare Provider Details

I. General information

NPI: 1073870945
Provider Name (Legal Business Name): VIKAS PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEALTHY WAY
OCEANSIDE NY
11572-1551
US

IV. Provider business mailing address

100 BANKS AVE APT 1358
ROCKVILLE CENTRE NY
11570-6215
US

V. Phone/Fax

Practice location:
  • Phone: 516-632-4905
  • Fax:
Mailing address:
  • Phone: 201-637-5460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number294834
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number294834
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: