1700161924 NPI number — JAYESHKUMAR S PATEL MD PC

Table of content: (NPI 1700161924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700161924 NPI number — JAYESHKUMAR S PATEL MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAYESHKUMAR S PATEL MD PC
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:
1700161924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
550 SUMMIT AVE
Provider Second Line Business Mailing Address:
BASEMENT
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07306-2707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-209-1802
Provider Business Mailing Address Fax Number:
201-604-8400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 BALDWIN RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PARSIPPANY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07054-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-209-1802
Provider Business Practice Location Address Fax Number:
201-604-8400
Provider Enumeration Date:
10/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
JAYESHKUMAR
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
201-209-1802

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  25MA06719700 , 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: 8551804 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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