Healthcare Provider Details

I. General information

NPI: 1063713378
Provider Name (Legal Business Name): NISHABEN D PATEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NISHA PATEL M.D.

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 635
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-2647
  • Fax: 585-275-0707
Mailing address:
  • Phone: 585-275-2647
  • Fax: 585-275-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number097044
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number274877
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: