Healthcare Provider Details

I. General information

NPI: 1952493298
Provider Name (Legal Business Name): RAOJI S PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 BROAD ST
STATEN ISLAND NY
10304-2033
US

IV. Provider business mailing address

2 SANDALWOOD DR
EAST BRUNSWICK NJ
08816-4046
US

V. Phone/Fax

Practice location:
  • Phone: 718-273-7749
  • Fax:
Mailing address:
  • Phone: 732-254-1192
  • Fax: 718-981-1431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number127154-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: