Healthcare Provider Details

I. General information

NPI: 1497041776
Provider Name (Legal Business Name): TEJAS BHARAT PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 VETERANS RD W STE 2F
STATEN ISLAND NY
10309-2504
US

IV. Provider business mailing address

2955 VETERANS RD W STE 2F
STATEN ISLAND NY
10309-2504
US

V. Phone/Fax

Practice location:
  • Phone: 929-200-3003
  • Fax: 929-224-0696
Mailing address:
  • Phone: 929-200-3003
  • Fax: 929-224-0696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number282042
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: