1013983998 NPI number — DR. MANISH S PATEL MD

Table of content: DR. MANISH S PATEL MD (NPI 1013983998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013983998 NPI number — DR. MANISH S PATEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
MANISH
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1013983998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 PATERSON ST
Provider Second Line Business Mailing Address:
ROOM 2330
Provider Business Mailing Address City Name:
NEW BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08901-1962
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-235-6539
Provider Business Mailing Address Fax Number:
732-235-7144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 PATERSON ST
Provider Second Line Business Practice Location Address:
ROOM 2330
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901-1962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-235-6539
Provider Business Practice Location Address Fax Number:
732-235-7144
Provider Enumeration Date:
02/28/2006

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: 207R00000X , with the licence number:  25MA08332100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: 036116200 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: P00758839 . This is a "R R MCR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "CORVEL COR CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 188794 . This is a "ATHEM BC/BS VA/HK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "MULTI PLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: PAR . This is a "MID-ATLANTIC VICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5902100 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: -028 . This is a "CHAMPUS/TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010202906 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0169820 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5902100 . This is a "BC/BS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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