Healthcare Provider Details

I. General information

NPI: 1245648203
Provider Name (Legal Business Name): SAURIN RAMABHAI PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E MAIN ST STE 120
PATCHOGUE NY
11772-3114
US

IV. Provider business mailing address

325 E MAIN ST STE 120
PATCHOGUE NY
11772-3114
US

V. Phone/Fax

Practice location:
  • Phone: 631-654-3278
  • Fax: 631-654-1474
Mailing address:
  • Phone: 631-654-3278
  • Fax: 631-654-1474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD453062
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number252562
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierA400177556
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerNYS MEDICARE
# 2
Identifier397432ZFL3
Identifier TypeOTHER
Identifier State
Identifier IssuerMEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: