MEDICARE: VISHAL PATEL MD

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	207RA0401X	Addiction Medicine (Internal Medicine) Physician	320030	NY

General Provider Information

NPI Number	:	1144783168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VISHAL PATEL MD

Provider Business Mailing Address
First Line	:	611 W 56TH ST APT 4F
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-3704
Country	:	US
Telephone Number	:	601-955-3991
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 W 125TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4439
Country	:	US
Telephone Number	:	212-636-4840
Fax Number	:

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

Provider Enumeration Date	:	04/08/2019
Last Update Date	:	10/20/2023

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