1184766701 NPI number — MR. AMBALAL K PATEL PHARMACIST

Table of content: MR. AMBALAL K PATEL PHARMACIST (NPI 1184766701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184766701 NPI number — MR. AMBALAL K PATEL PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
AMBALAL
Provider Middle Name:
K
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
M

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:
1184766701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 SAMPSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAYVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11782-1313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-567-3070
Provider Business Mailing Address Fax Number:
631-968-9049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 E MAIN ST STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PATCHOGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11772-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-475-6666
Provider Business Practice Location Address Fax Number:
631-768-9049
Provider Enumeration Date:
02/12/2007

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: 183500000X , with the licence number:  031894 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 031894 . This is a "NYSTATE RPH LIC.NO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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