=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134196942
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAHUL PATEL D.P.M.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2006
-----------------------------------------------------
Last Update Date | 10/29/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14846 61ST RD
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-961-8087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14846 61ST RD
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11367-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-620-3168
-----------------------------------------------------
Fax | 866-744-2481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | N006086
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------