Provider Demographics
NPI:1093905184
Name:FONTANILLA, HIRAL P (MD)
Entity Type:Individual
Prefix:
First Name:HIRAL
Middle Name:P
Last Name:FONTANILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HIRAL
Other - Middle Name:P
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:629 CRANBURY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4096
Mailing Address - Country:US
Mailing Address - Phone:732-390-7750
Mailing Address - Fax:732-390-7725
Practice Address - Street 1:9 CENTRE DR STE 115
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-5153
Practice Address - Country:US
Practice Address - Phone:609-655-5755
Practice Address - Fax:609-655-5725
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA090958002085R0001X
PAMD4449142085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0290246Medicaid
NJ1790396281OtherTITAN HEALTH GROUP NPI#
NJ0290246Medicaid