Provider Demographics
NPI:1871589739
Name:PATEL, SURESHCHANDRA GANGARAM (MD)
Entity type:Individual
Prefix:DR
First Name:SURESHCHANDRA
Middle Name:GANGARAM
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 CHAFFEE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1807
Mailing Address - Country:US
Mailing Address - Phone:718-439-9620
Mailing Address - Fax:718-439-3289
Practice Address - Street 1:5801 5TH AVE
Practice Address - Street 2:MEDICAL DENTAL OFFICE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3819
Practice Address - Country:US
Practice Address - Phone:718-439-9620
Practice Address - Fax:718-439-3289
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190163208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01825272Medicaid