Van Patten was born in Brooklyn, New York, and grew up in Massapequa, New York. He is the half-brother of Dick Van Patten and Joyce Van Patten, and the uncle of Vincent Van Patten and Talia Balsam. He graduated from Massapequa High School in 1977, in the same class as musician Brian Setzer and football player Brian Baldinger.
As an actor, he is perhaps best known for portraying Mario "Salami" Pettrino on The White Shadow. He also played the villainous teenager Peter Stegman in Class of 1984 and Max Keller on The Master.
In 2001, together with Terence Winter, Van Patten won both the Edgar Award and Writers Guild of America Award for Episodic Drama for The Sopranos episode "Pine Barrens", directed by Steve Buscemi. In 2004, Van Patten directed an episode called "Long Term Parking", which won the Primetime Emmy Award for Outstanding Writing for a Drama Series.
He has been nominated at the Primetime Emmy Awards on ten different occasions for directing: The Sopranos episodes "Amour Fou", "Whoever Did This", "Long Term Parking" and "Members Only", The Pacific episode "Okinawa", the Game of Thrones pilot "Winter Is Coming", and Boardwalk Empire episodes "To the Lost", "Margate Sands", "Farewell Daddy Blues" and the series finale "Eldorado", winning the award for "To the Lost" in 2012.
