Provider Demographics
NPI:1912921651
Name:PATEL, RAJESH C (MD)
Entity type:Individual
Prefix:DR
First Name:RAJESH
Middle Name:C
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 RONOAKE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2057
Mailing Address - Country:US
Mailing Address - Phone:631-369-7660
Mailing Address - Fax:631-369-7688
Practice Address - Street 1:715 RONOAKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2057
Practice Address - Country:US
Practice Address - Phone:631-369-7660
Practice Address - Fax:631-369-7688
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY194902OtherHIP
NYAA50435OtherMDNY HEALTHCARE
NY01919337Medicaid
NY077AS1OtherEMPIRE BLUE CROSS BLUE SH
NY113643307OtherCOMMERCIAL
NY2593878OtherGHI
NY194902OtherHIP
NY113643307OtherCOMMERCIAL
NY077AS1OtherEMPIRE BLUE CROSS BLUE SH