Provider Demographics
NPI:1184820557
Name:PATEL, ANKITKUMAR KIRANKUMAR (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ANKITKUMAR
Middle Name:KIRANKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BRADFORD RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2644
Mailing Address - Country:US
Mailing Address - Phone:732-494-9138
Mailing Address - Fax:
Practice Address - Street 1:123 HIGHLAND AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1527
Practice Address - Country:US
Practice Address - Phone:973-748-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT190919207R00000X
PAMD438763207R00000X
NJ25MA08748200207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD438763Medicare UPIN
PAMT190919Medicare UPIN