Healthcare Provider Details

I. General information

NPI: 1194287052
Provider Name (Legal Business Name): JAIME PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 WESTCHESTER AVE STE 200
PURCHASE NY
10577-2531
US

IV. Provider business mailing address

3020 WESTCHESTER AVE STE 200
PURCHASE NY
10577-2531
US

V. Phone/Fax

Practice location:
  • Phone: 914-996-7786
  • Fax:
Mailing address:
  • Phone: 914-996-7786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401416892
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number061703
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: