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General NPI Number Information
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NPI Number | 1871589739
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Entity Type | Individual
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Provider Name | SURESHCHANDRA GANGARAM PATEL M.D
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Gender | Male
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 07/06/2014
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Provider Practice Location Address
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Address Line | 5801 5TH AVE MEDICAL DENTAL OFFICE
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City | BROOKLYN
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State | NY
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Zip | 11220-3819
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Country | US
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Telephone | 718-439-9620
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Fax | 718-439-3289
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Provider Business Mailing Address
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Address Line | 17 CHAFFEE AVE
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City | ALBERTSON
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State | NY
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Zip | 11507-1807
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Country | US
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Telephone | 718-439-9620
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Fax | 718-439-3289
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 190163
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License Number State | NY
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