MEDICARE: KEVIN PATEL PHYSICIAN ASSISTANT

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	363A00000X	Physician Assistant	022935	NY
2	363A00000X	Physician Assistant		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205302593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN PATEL PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	555 N BROADWAY
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-2134
Country	:	US
Telephone Number	:	516-597-5070
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 N BROADWAY
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-2134
Country	:	US
Telephone Number	:	516-597-5070
Fax Number	:

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

Provider Enumeration Date	:	10/15/2018
Last Update Date	:	02/28/2022

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