MEDICARE: NIMISHABEN PATEL RPA-C

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	363AM0700X	Medical Physician Assistant	012863	NY

General Provider Information

NPI Number	:	1205156544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIMISHABEN PATEL RPA-C

Provider Business Mailing Address
First Line	:	33 W 125TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4512
Country	:	US
Telephone Number	:	212-289-5795
Fax Number	:	212-410-4424

Provider Business Practice Location Address
First Line	:	33 W 125TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4512
Country	:	US
Telephone Number	:	212-289-5795
Fax Number	:	212-410-4424

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

Provider Enumeration Date	:	06/09/2010
Last Update Date	:	01/05/2022

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Directions to “ NIMISHABEN PATEL RPA-C” Practice Location

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