Provider Demographics
NPI:1124067962
Name:PATEL, SURESH M (MD)
Entity type:Individual
Prefix:
First Name:SURESH
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 WATER STREET
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:20620 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1524
Practice Address - Country:US
Practice Address - Phone:718-479-6600
Practice Address - Fax:718-217-3546
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-09-23
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Provider Licenses
StateLicense IDTaxonomies
NY170560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01839514Medicaid
NYA400123895Medicare PIN
NYE77959Medicare UPIN