1164711453 NPI number — BHUMIKA PATEL M.D.

Table of content: BHUMIKA PATEL M.D. (NPI 1164711453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164711453 NPI number — BHUMIKA PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
BHUMIKA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164711453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT. OF MEDICINE HSC T16
Provider Second Line Business Mailing Address:
STONY BROOK UNIVERSITY HOSPITAL
Provider Business Mailing Address City Name:
STONY BROOK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11794-8160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-444-4000
Provider Business Mailing Address Fax Number:
631-444-2493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 DR MARTIN LUTHER KING JR ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33704-4222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-873-1177
Provider Business Practice Location Address Fax Number:
631-444-2493
Provider Enumeration Date:
04/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0201X , with the licence number:  ME124286 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 025099100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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