Healthcare Provider Details

I. General information

NPI: 1780036053
Provider Name (Legal Business Name): CITY MEDICAL OFFICE PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 RALPH PL STE 105
STATEN ISLAND NY
10304-4405
US

IV. Provider business mailing address

980 W FINGERBOARD RD
STATEN ISLAND NY
10304-4414
US

V. Phone/Fax

Practice location:
  • Phone: 718-697-7286
  • Fax: 888-501-6619
Mailing address:
  • Phone: 718-213-1416
  • Fax: 888-501-6619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number262002
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number262002
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number265750
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number265750
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number265750
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number262002
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number265750
License Number StateNY
# 8
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number265750
License Number StateNY

VIII. Authorized Official

Name: DR. RATTAN M PATEL
Title or Position: DOCTOR
Credential: MD
Phone: 718-213-1416