Basic Information
| Provider Information | |||||||||
| NPI: | 1477698272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATIL | ||||||||
| FirstName: | PUSHPA | ||||||||
| MiddleName: | SHYAM | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 MORGAN LN | ||||||||
| Address2: | |||||||||
| City: | POUGHQUAG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125705708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8452277956 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 ROSS CIR | ||||||||
| Address2: | |||||||||
| City: | POUGHKEEPSIE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 126011078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454528000 | ||||||||
| FaxNumber: | 8454375180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0805X | 165401-1 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
No ID Information.