1336168426 NPI number — MANJUL PATWARDHAN MD PROFESSIONAL CORPORATION

Table of content: (NPI 1336168426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336168426 NPI number — MANJUL PATWARDHAN MD PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANJUL PATWARDHAN MD PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336168426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
898 PERSIMMON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYVALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94087-1819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-219-3130
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10353 TORRE AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
CUPERTINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95014-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-725-1777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PATWARDHAN
Authorized Official First Name:
MANJUL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT AND OWNER
Authorized Official Telephone Number:
408-725-1777

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A69182 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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