Provider Demographics
NPI:1245521673
Name:MITUL R. PATEL M.D. P.C.
Entity type:Organization
Organization Name:MITUL R. PATEL M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-289-0900
Mailing Address - Street 1:250 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4800
Mailing Address - Country:US
Mailing Address - Phone:631-289-0900
Mailing Address - Fax:631-758-2542
Practice Address - Street 1:250 PATCHOGUE YAPHANK RD
Practice Address - Street 2:SUITE 7
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4800
Practice Address - Country:US
Practice Address - Phone:631-289-0900
Practice Address - Fax:631-758-2542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203391208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty