Individual
MITUL R PATEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
250 PATCHOGUE YAPHANK RD, SUITES # 7, EAST PATCHOGUE, NY 11772-4800
(631) 289-0900
(631) 569-4909
Mailing address
250 PATCHOGUE YAPHANK RD, SUITES # 7, EAST PATCHOGUE, NY 11772-4800
(631) 289-0900
(631) 569-4909
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
203391
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004AF3
EMPIRE BLUE CROSS ID
NY
05
—
01849976
—
NY
05
—
018499760
—
NY
01
—
100693
HIP HEALTH PLAN ID NO.
NY
01
—
2046588
AETNA PROVIDER NUMBER
NY
01
—
67712
VYTRA HEALTH ID NO.
NY
01
—
P00214307
RR MEDICARE ID NO.
NY
01
—
P452012
OXFORD HEALTH ID NO.
NY
Enumeration date
11/08/2005
Last updated
11/15/2014
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