Provider Demographics
NPI:1164454997
Name:PATEL, NILESHKUMAR J (MD)
Entity Type:Individual
Prefix:DR
First Name:NILESHKUMAR
Middle Name:J
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 1:31 VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1542
Mailing Address - Country:US
Mailing Address - Phone:732-821-4888
Mailing Address - Fax:732-821-4888
Practice Address - Street 1:31 VILLAGE RD
Practice Address - Street 2:
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1542
Practice Address - Country:US
Practice Address - Phone:732-821-4888
Practice Address - Fax:732-821-4888
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166871207R00000X
NJ45313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY80D902Medicare PIN