1215108188 NPI number — DR. PRIYESH PATEL M.D.

Table of content: DR. PRIYESH PATEL M.D. (NPI 1215108188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215108188 NPI number — DR. PRIYESH PATEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PATEL
Provider First Name:
PRIYESH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1215108188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1295 ROUTE 38
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAINESPORT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08036-2702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-914-7017
Provider Business Mailing Address Fax Number:
609-261-4180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 ARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT LAUREL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08054-3188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-261-4500
Provider Business Practice Location Address Fax Number:
609-261-4180
Provider Enumeration Date:
03/18/2008

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: 2085R0202X , with the licence number:  25MA09064400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0362344 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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