Healthcare Provider Details

I. General information

NPI: 1275725160
Provider Name (Legal Business Name): PRAKASHKUMAR GOVINDBHAI PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 WINCHESTER BLVD
QUEENS VILLAGE NY
11427-2128
US

IV. Provider business mailing address

8029 252ND ST
BELLEROSE NY
11426-2613
US

V. Phone/Fax

Practice location:
  • Phone: 718-464-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number245716
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: