Provider Demographics
NPI:1255661401
Name:MAYUR V. PATEL, , M.D., PA
Entity Type:Organization
Organization Name:MAYUR V. PATEL, , M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYUR
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-530-1058
Mailing Address - Street 1:654 NEWMAN SPRINGS RD
Mailing Address - Street 2:SUITE D & E
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1750
Mailing Address - Country:US
Mailing Address - Phone:732-530-1058
Mailing Address - Fax:732-530-1419
Practice Address - Street 1:654 NEWMAN SPRINGS RD
Practice Address - Street 2:SUITE D & E
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1750
Practice Address - Country:US
Practice Address - Phone:732-530-1058
Practice Address - Fax:732-530-1419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07534600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH52262Medicare UPIN