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General NPI Number Information
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NPI Number | 1699928846
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Entity Type | Individual
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Provider Name | PALAKKUMAR B PATEL PA -C
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Gender | Male
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Dates
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Enumeration Date | 11/01/2008
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Last Update Date | 11/01/2008
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Provider Practice Location Address
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Address Line | 60 N COUNTRY RD STE 203
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2188
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Country | US
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Telephone | 631-928-3444
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Fax |
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Provider Business Mailing Address
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Address Line | 1148 GRUNDY AVE
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City | HOLBROOK
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State | NY
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Zip | 11741-2633
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Country | US
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Telephone | 631-219-3557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 012943
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License Number State | NY
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