Provider Demographics
NPI:1083639512
Name:PATEL, MANMOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MANMOHAN
Middle Name:
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MANMOHAN
Other - Middle Name:APABHAI
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 71176
Mailing Address - Street 2:CARDIO PULMONARY DIAGNOSTIC LLC
Mailing Address - City:FAIRFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07004
Mailing Address - Country:US
Mailing Address - Phone:973-596-1200
Mailing Address - Fax:973-596-9212
Practice Address - Street 1:340 AIRIS DR # SUITE 203
Practice Address - Street 2:CARDIO PULMONARY DIAGNOSTIC LLC, NEWARK LIBERTY INTERNA
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-3715
Practice Address - Country:US
Practice Address - Phone:973-596-1200
Practice Address - Fax:973-596-9212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03560900174400000X
NJ25MA3560900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ476136Medicare ID - Type Unspecified