MEDICARE: DR. SUBODH GOPALDAS PATEL DDS

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	1223G0001X	General Practice Dentistry	035806	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	:	1962492728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUBODH GOPALDAS PATEL DDS

Provider Business Mailing Address
First Line	:	278 CHARLES ST
Second Line	:
City	:	CLIFTON
State	:	NJ
Zip	:	07013-3851
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	902 HUNTS POINT AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10474-5403
Country	:	US
Telephone Number	:	718-328-2570
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/08/2007

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