Basic Information
Provider Information | |||||||||
NPI: | 1245648203 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PATEL | ||||||||
FirstName: | SAURIN | ||||||||
MiddleName: | RAMABHAI | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 325 E MAIN ST STE 120 | ||||||||
Address2: |   | ||||||||
City: | PATCHOGUE | ||||||||
State: | NY | ||||||||
PostalCode: | 117723114 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6316543278 | ||||||||
FaxNumber: | 6316541474 | ||||||||
Practice Location | |||||||||
Address1: | 325 E MAIN ST STE 120 | ||||||||
Address2: |   | ||||||||
City: | PATCHOGUE | ||||||||
State: | NY | ||||||||
PostalCode: | 117723114 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6316543278 | ||||||||
FaxNumber: | 6316541474 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/23/2014 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | MD453062 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | 252562 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
ID | Type | State | Issuer | Description | A400177556 | 01 | NY | NYS MEDICARE | OTHER | 397432ZFL3 | 01 |   | MEDICARE | OTHER |