MEDICARE: JYOTI N PATEL

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	183500000X	Pharmacist	030647	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	030647	OTHER	NY	NYS PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1740512318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JYOTI N PATEL

Provider Business Mailing Address
First Line	:	19514 MCLAUGHLIN AVE
Second Line	:
City	:	HOLLIS
State	:	NY
Zip	:	11423-1152
Country	:	US
Telephone Number	:	718-464-7229
Fax Number	:	718-464-1848

Provider Business Practice Location Address
First Line	:	70 E 161ST ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-2207
Country	:	US
Telephone Number	:	718-665-1163
Fax Number	:	718-665-8356

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

Provider Enumeration Date	:	02/08/2010
Last Update Date	:	02/08/2010

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