Healthcare Provider Details

I. General information

NPI: 1356627475
Provider Name (Legal Business Name): JAY PATEL PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 HILLSIDE RD SUITE A
PELHAM NY
10803
US

IV. Provider business mailing address

620 W 42ND ST APT S-41M
NEW YORK NY
10036
US

V. Phone/Fax

Practice location:
  • Phone: 914-738-2400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number056218
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: