Provider Demographics
NPI:1053343871
Name:PATEL, MITAL B (DPM)
Entity type:Individual
Prefix:DR
First Name:MITAL
Middle Name:B
Last Name:PATEL
Suffix:
Gender:F
Credentials:DPM
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Mailing Address - Street 1:20 HICKSVILLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5819
Mailing Address - Country:US
Mailing Address - Phone:201-681-2654
Mailing Address - Fax:855-959-1613
Practice Address - Street 1:20 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5819
Practice Address - Country:US
Practice Address - Phone:516-590-7744
Practice Address - Fax:844-335-7404
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN006053213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02669029Medicaid
NY02669029Medicaid
NY06968Medicare UPIN
NY06968Medicare UPIN