1881109221 NPI number — PATEL CARDIOVASCULAR CONSULTANTS LLC

Table of content: (NPI 1881109221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881109221 NPI number — PATEL CARDIOVASCULAR CONSULTANTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATEL CARDIOVASCULAR CONSULTANTS LLC
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:
1881109221
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 PENNINGTON TITUSVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENNINGTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08534-4103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-588-8922
Provider Business Mailing Address Fax Number:
267-358-5448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 MIDDLETOWN BLVD STE 101C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANGHORNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-560-5461
Provider Business Practice Location Address Fax Number:
267-358-5448
Provider Enumeration Date:
12/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
MRUGESH
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
215-588-8922

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MD068305L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1034883300001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 656194 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 003805991 . This is a "PABS HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 656194 . This is a "MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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