Provider Demographics
NPI:1316917032
Name:PATEL, NINA SAMIR (DDS)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:SAMIR
Last Name:PATEL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S TYSON AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2017
Mailing Address - Country:US
Mailing Address - Phone:516-355-0155
Mailing Address - Fax:516-355-0157
Practice Address - Street 1:22 S TYSON AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2017
Practice Address - Country:US
Practice Address - Phone:516-355-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048437-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02187988Medicaid