Provider Demographics
NPI:1366724932
Name:PATEL, NINA (PA)
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:1000 MONTAUK HIGHWAY
Mailing Address - Street 2:AVANCED PRACTICE PROFESSIONALS
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795
Mailing Address - Country:US
Mailing Address - Phone:631-376-3251
Mailing Address - Fax:631-376-3798
Practice Address - Street 1:1000 MONTAUK HWY
Practice Address - Street 2:AVANCED PRACTICE PROFESSIONALS
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4927
Practice Address - Country:US
Practice Address - Phone:631-376-3251
Practice Address - Fax:631-376-3798
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
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Provider Licenses
StateLicense IDTaxonomies
NY014906363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical