Provider Demographics
NPI:1235306952
Name:PATEL, JAYMICA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYMICA
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:52 W RED BANK AVE
Mailing Address - Street 2:SUITE 26
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-1695
Mailing Address - Country:US
Mailing Address - Phone:856-853-2025
Mailing Address - Fax:856-845-8024
Practice Address - Street 1:509 N BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1617
Practice Address - Country:US
Practice Address - Phone:856-686-5396
Practice Address - Fax:856-686-5332
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08381000207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ186872Medicaid
NJ12641PSWOtherMEDICARE PROVIDER NUMBER