Healthcare Provider Details

I. General information

NPI: 1932989654
Provider Name (Legal Business Name): BRIDGEVIEW MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/02/2023
Certification Date: 09/30/2023
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:
Mailing address:
  • Phone: 929-200-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TEJAS B PATEL
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 929-200-3003