MEDICARE: JITENDRA K 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	207RR0500X	Rheumatology Physician	155137	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	:	1669410775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JITENDRA K PATEL MD

Provider Business Mailing Address
First Line	:	3 COLT PL
Second Line	:
City	:	OLD WESTBURY
State	:	NY
Zip	:	11568-1101
Country	:	US
Telephone Number	:	718-258-7019
Fax Number	:	718-692-3772

Provider Business Practice Location Address
First Line	:	3420 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2607
Country	:	US
Telephone Number	:	718-258-7019
Fax Number	:	718-692-3772

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/08/2007

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