Provider Demographics
NPI:1063534741
Name:PATRICE, GEOFFROY HALLAH (MD)
Entity type:Individual
Prefix:
First Name:GEOFFROY
Middle Name:HALLAH
Last Name:PATRICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3802
Mailing Address - Country:US
Mailing Address - Phone:718-241-4621
Mailing Address - Fax:718-241-4622
Practice Address - Street 1:914 E 84TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3802
Practice Address - Country:US
Practice Address - Phone:718-241-4621
Practice Address - Fax:718-241-4622
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141929207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY71S501OtherBLUE CROSS BLUE SHIELD
NY01198693OtherWORKERS'S COMPENSATION
NY00766596Medicaid
NY141929OtherHIP
NYP570487OtherOXFORD
NY0084492OtherGHI
NY141929-B16OtherHEALTHFIRST
NY71S501OtherBLUE CROSS BLUE SHIELD
NYP570487OtherOXFORD