Provider Demographics
NPI:1073691226
Name:PATEL, KALPESH P (DO)
Entity Type:Individual
Prefix:
First Name:KALPESH
Middle Name:P
Last Name:PATEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 GEORGE ST
Mailing Address - Street 2:3RD FLOOR, PROVIDER ENROLLMENT
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2008
Mailing Address - Country:US
Mailing Address - Phone:732-235-6772
Mailing Address - Fax:732-235-8347
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-685-2864
Practice Address - Fax:908-704-3777
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB079951208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0124435Medicaid