Provider Demographics
NPI:1174759419
Name:PATEL, SAMIR CHAMPAK (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:CHAMPAK
Last Name:PATEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1500 ROUTE 112
Mailing Address - Street 2:BLDG 4
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-8055
Mailing Address - Country:US
Mailing Address - Phone:631-751-3000
Mailing Address - Fax:631-509-6559
Practice Address - Street 1:611 GIDNEY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2823
Practice Address - Country:US
Practice Address - Phone:917-796-3016
Practice Address - Fax:845-561-6168
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2020-01-22
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Provider Licenses
StateLicense IDTaxonomies
NY252973-1207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine