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General NPI Number Information
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NPI Number | 1114345055
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Entity Type | Organization
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Legal Business Name | RAKESH B. PATEL PHYSICIAN PC
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Dates
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Enumeration Date | 03/28/2014
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Last Update Date | 03/28/2014
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Provider Practice Location Address
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Address Line | 48 ROUTE 25A SUITE 103
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City | SMITHTOWN
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State | NY
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Zip | 11787-1431
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Country | US
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Telephone | 631-784-7373
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Fax | 631-784-7359
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Provider Business Mailing Address
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Address Line | PO BOX 169
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City | HUNTINGTON STATION
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State | NY
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Zip | 11746-0139
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Country | US
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Telephone | 631-784-7373
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Fax | 631-784-7359
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. RAKESH B PATEL
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Credential | M.D.
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Telephone | 631-784-7373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 204473
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License Number State | NY
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