Provider Demographics
NPI:1194723551
Name:PATEL, JIVANLAL M (M D)
Entity type:Individual
Prefix:
First Name:JIVANLAL
Middle Name:M
Last Name:PATEL
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 W 52ND ST APT 26J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-6296
Mailing Address - Country:US
Mailing Address - Phone:814-715-4597
Mailing Address - Fax:
Practice Address - Street 1:310 W 52ND ST APT 26J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6296
Practice Address - Country:US
Practice Address - Phone:814-715-4597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135792-1207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C30571Medicare UPIN
C30571Medicare UPIN
PA1013422100001Medicaid
PA116223RJDMedicare PIN