MEDICARE: DR. ROSHANI M PATEL D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI02475300	NJ
2	122300000X	Dentist	0555-771	NY

General Provider Information

NPI Number	:	1114205382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSHANI M PATEL D.M.D.

Provider Business Mailing Address
First Line	:	45 E 51ST ST
Second Line	:
City	:	BAYONNE
State	:	NJ
Zip	:	07002-4116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 W 57TH STREET SUITE 1816
Second Line	:	1816
City	:	NEW YORK
State	:	NY
Zip	:	10019
Country	:	US
Telephone Number	:	212-873-1234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	03/21/2014

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