Provider Demographics
NPI:1104844778
Name:PATEL, SUHAS R (MD)
Entity Type:Individual
Prefix:
First Name:SUHAS
Middle Name:R
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 STATE ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4077
Mailing Address - Country:US
Mailing Address - Phone:732-663-0099
Mailing Address - Fax:732-663-1359
Practice Address - Street 1:1205 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4077
Practice Address - Country:US
Practice Address - Phone:732-663-0099
Practice Address - Fax:732-663-1359
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07354400207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0059757Medicaid
NJ057352Medicare ID - Type Unspecified
NJ0059757Medicaid