Basic Information
| Provider Information | |||||||||
| NPI: | 1003147109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PATEL | ||||||||
| FirstName: | BHARGAV | ||||||||
| MiddleName: | DAMODAR | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1473 AMSTERDAM AVE | ||||||||
| Address2: | STORE #1 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100277472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124914911 | ||||||||
| FaxNumber: | 2124914916 | ||||||||
| Practice Location | |||||||||
| Address1: | 1473 AMSTERDAM AVE | ||||||||
| Address2: | STORE #1 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100277472 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124914911 | ||||||||
| FaxNumber: | 2124914916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2010 | ||||||||
| LastUpdateDate: | 01/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 28RI02263100 | NJ | N | Pharmacy Service Providers | Pharmacist | 183500000X | 045639 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.