Provider Demographics
NPI:1053335083
Name:PATEL, SANJAY (DPM)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 SEASIDE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4625
Mailing Address - Country:US
Mailing Address - Phone:203-876-7736
Mailing Address - Fax:
Practice Address - Street 1:309 SEASIDE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4625
Practice Address - Country:US
Practice Address - Phone:203-876-7736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000509213E00000X, 213ES0103X, 213ES0131X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000509J185OtherCIGNA HEALTHCARE
CT480035180OtherRAILROAD MEDICARE
CTNHS138OtherOXFORD HEALTH PLAN
CT030000509CT05OtherBLUE CROSS BLUE SHIELD
CT004099257Medicaid
CT030000509CT06OtherBLUE CROSS BLUE SHIELD
CT2885050004OtherCIGNA HEALTHCARE
CTNHS138OtherOXFORD HEALTH PLAN
CT4714640001Medicare NSC
CT480000907Medicare PIN