Healthcare Provider Details

I. General information

NPI: 1861488041
Provider Name (Legal Business Name): DHARMESH R PATEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FRONT ST STE C
VESTAL NY
13850-1559
US

IV. Provider business mailing address

200 FRONT ST STE C
VESTAL NY
13850-1559
US

V. Phone/Fax

Practice location:
  • Phone: 607-239-5694
  • Fax: 607-239-5720
Mailing address:
  • Phone: 607-239-5694
  • Fax: 607-239-5720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number247185
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number247185
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number247185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: