=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922086933
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOGENDRA R PATEL M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 903 FOREST AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10310-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-273-6666
-----------------------------------------------------
Fax | 718-816-1043
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 903 FOREST AVE
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10310-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-273-6666
-----------------------------------------------------
Fax | 718-816-1043
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 120705
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------