Provider Demographics
NPI:1962139667
Name:PATIL, AMEY GOPINATH
Entity type:Individual
Prefix:DR
First Name:AMEY
Middle Name:GOPINATH
Last Name:PATIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 JONES ST APT 504
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-3844
Mailing Address - Country:US
Mailing Address - Phone:917-951-4589
Mailing Address - Fax:917-590-0758
Practice Address - Street 1:24 JONES ST APT 504
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3844
Practice Address - Country:US
Practice Address - Phone:917-951-4589
Practice Address - Fax:917-590-0758
Is Sole Proprietor?:No
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.01341181223X2210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X2210XDental ProvidersDentistOrofacial Pain