Healthcare Provider Details

I. General information

NPI: 1528453321
Provider Name (Legal Business Name): NISHA A PATEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 EAST ADAMS ST 5TH FL
SYRACUSE NY
13210
US

IV. Provider business mailing address

331 NEWMAN SPRINGS ROAD BLDG. 2, SUITE 220
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5726
  • Fax: 315-464-2510
Mailing address:
  • Phone: 732-807-0877
  • Fax: 201-751-1680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number310443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: